Michael David Jackson

Primary specialty

Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0808X

License

201401353RN Issued in OR

Practice address

1605 E Lincoln Rd
Woodburn, OR 97071-5137

Phone

(503) 982-9300

NPI assigned

Nov 28, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1543363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736294400000",
    "number": "1467922856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2045 SILVERTON RD NE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973010100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1605 E LINCOLN RD",
            "city": "WOODBURN",
            "state": "OR",
            "postal_code": "970715137",
            "telephone_number": "503-982-9300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MICHAEL",
        "middle_name": "DAVID",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-11-28",
        "last_updated": "2025-01-08",
        "certification_date": "2025-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0809X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Adult",
            "state": "OR",
            "license": "201401353RN",
            "primary": false
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "OR",
            "license": "201401353RN",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chungah E Huggett, RPH
• Alyssa Hurst
• Icco, LLC
• Samantha Lynn Irvin
• Mikhail Izraylev
• Cole Janini
• Megan Anna Jantzi, SLP
• Dylan Jessen
• Marlon Johns, DC
• Annika Michele Johnson Campbell, PSYD

• Psychiatric/Mental Health Registered Nurse in Woodburn, OR
• Providers in Woodburn, OR by specialty
• Psychiatric/Mental Health Registered Nurse in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.