Shawntae Jackson

Primary specialty

Personal Care AttendantTaxonomy code 3747P1801X

Practice address

2270 NW Overton St
Portland, OR 97210-2927

Phone

(503) 241-6051

NPI assigned

Dec 2, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Shawntae Cooper Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Cascadia Health

  • Multi-Specialty Clinic/Center
  • Portland, OR
  • NPI 1629155825
  NPD (past)

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

{
    "created_epoch": "1669939200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669939200000",
    "number": "1558071399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8459",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972078459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2270 NW OVERTON ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972102927",
            "telephone_number": "503-241-6051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SHAWNTAE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-12-02",
        "last_updated": "2022-12-02",
        "certification_date": "2022-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3747P1801X",
            "taxonomy_group": "",
            "desc": "Technician, Personal Care Attendant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHAWNTAE",
            "last_name": "COOPER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Raymond Thomas Jackson
• Robin Naumann Jackson, CCC-SLP
• Robyn Yolanda Jackson
• Shanean L Jackson
• Shannon E Jackson, MD
• Steve R Jackson, MA
• Steven Jackson, MSW
• Steven Colin Jackson, MD
• Stuart Mark Jackson, LCSW
• Talia Jackson

• Personal Care Attendant in Portland, OR
• Providers in Portland, OR by specialty
• Personal Care Attendant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2022; 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.