Melinda Ann Jackson

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

MD12772 Issued in OR

Practice address

13007 NE Glisan St
Portland, OR 97230-2545

Phone

(503) 215-6556

Fax

(503) 215-0685

NPI assigned

Mar 14, 2006

Last updated

Jul 13, 2026By the provider in NPPES

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

• Dr. Melinda Ann Lee Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Providence Health System Oregon

  dba Providence Elder Place Portland

  • Multi-Specialty Clinic/Center
  • Portland, OR
  • NPI 1023098118
  NPD (past)

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1558330647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13007 NE GLISAN ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972302545",
            "telephone_number": "503-215-6556",
            "fax_number": "503-215-0685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13007 NE GLISAN ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972302545",
            "telephone_number": "503-215-6556",
            "fax_number": "503-215-0685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MELINDA",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-14",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "OR",
            "license": "MD12772",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MELINDA",
            "last_name": "LEE",
            "middle_name": "ANN",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Laura Marie Jackson, FNP, CWCN
• Laurie Jackson, CADC
• Lloyd Chris Jackson, MCM, CADC I, CRM II
• Lydia Michelle Jackson
• Mallori A Jackson
• Melissa T Jackson, MS HUMAN SERVICES
• Michelle Jackson, M.S., OTR/L
• Natalie Jo Jackson
• Natasha Marie Jackson
• Nicole Jackson

• Geriatric Medicine (Internal Medicine) Physician in Portland, OR
• Providers in Portland, OR by specialty
• Geriatric Medicine (Internal Medicine) Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.