Active NPI
David John Jackson, LPN
- Licensed Practical Nurse
- Huber Heights, OH
National Provider Identifier
1619283470
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 140833
- Practice address
- 4301 Kitridge Rd
Huber Heights, OH 45424-6022 - Phone
- (937) 681-6484
- NPI assigned
- Aug 31, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 140833 | OH | Primary |
Addresses
Primary practice location
4301 Kitridge Rd
Huber Heights, OH 45424-6022
Mailing address
4301 Kitridge Rd
Huber Heights, OH 45424-6022
Phone (937) 681-6484
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 140833 | OH | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1283212800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1283212800000",
"number": "1619283470",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4301 KITRIDGE RD",
"city": "HUBER HEIGHTS",
"state": "OH",
"postal_code": "454246022",
"telephone_number": "937-681-6484"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4301 KITRIDGE RD",
"city": "HUBER HEIGHTS",
"state": "OH",
"postal_code": "454246022",
"telephone_number": "937-681-6484"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "DAVID",
"middle_name": "JOHN",
"credential": "LPN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-08-31",
"last_updated": "2010-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "OH",
"license": "140833",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Huber Heights, OH
- Saratou Arzika Ibrahim
- Kami Imes, LISW-S
- Interim Healthcare Hospice of Ohio, Inc. (Interim HealthCare Hospice of Dayton)
- Interim Healthcare of Dayton, Inc.
- Iridescence Wellness Studio LLC
- Misty A Jackson, LPN
- Mark S Jeffries, DO
- Jose Amalan Jesurajan
- Alicia Lorelei Jez, LISW
- Jlaat (Taylor Family Wellness Chiropractic)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.