Nicole R Jackson, MD, MPH

Primary specialty

Forensic Pathology PhysicianTaxonomy code 207ZF0201X

License

MD2019-0291 Issued in NM

Practice address

908 Jefferson St BLDG 2ND
Seattle, WA 98104-2433

Phone

(206) 731-3505

Fax

(206) 731-8555

NPI assigned

Apr 15, 2014

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Association of University Physicians

  • Anesthesiology Physician
  • Seattle, WA
  • NPI 1023041159
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1397520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682035200000",
    "number": "1457770638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 9TH AVE # 359792",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981042499",
            "telephone_number": "206-731-3505",
            "fax_number": "206-731-8555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "908 JEFFERSON ST BLDG 2ND",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981042433",
            "telephone_number": "206-731-3505",
            "fax_number": "206-731-8555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "NICOLE",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "MD, MPH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-04-15",
        "last_updated": "2023-04-21",
        "certification_date": "2023-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZF0201X",
            "taxonomy_group": "",
            "desc": "Pathology, Forensic Pathology",
            "state": "NM",
            "license": "MD2019-0291",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Allen Jackson
• Milo Corazon Jackson
• Mimi C Jackson, DC
• Molly Blackley Jackson, MD
• Myles Jackson
• Olivia Jackson, BA
• Ray Lawrence Jackson, DDS
• Renee Jackson, RT
• Rhianna Jackson
• Richard A Jackson, MB CHB FRCA

• Forensic Pathology Physician in Seattle, WA
• Providers in Seattle, WA by specialty
• Forensic Pathology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.