Lisa A Jackson, M.D.

Primary specialty

Public Health & General Preventive Medicine PhysicianTaxonomy code 2083P0901X

License

MD00027646 Issued in WA

Practice address

1730 Minor Ave
Seattle, WA 98101-1498

Phone

(206) 442-5216

NPI assigned

Mar 29, 2007

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 identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1254268800000",
    "number": "1639299290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 34584",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981241584",
            "telephone_number": "509-241-7349",
            "fax_number": "509-241-7628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1730 MINOR AVE",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981011498",
            "telephone_number": "206-442-5216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "LISA",
        "middle_name": "A",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-29",
        "last_updated": "2009-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083P0901X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": "WA",
            "license": "MD00027646",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8342040",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kinshasha Jackson
• Lashelle Donella Jackson
• Laura Elizabeth Jackson, PA-C
• Laura Heinemann Jackson, OTR/L
• Leah A Jackson
• Marie Deshazer Jackson
• Matthew Bryan Jackson, LMP
• Michael Allen Jackson
• Milo Corazon Jackson
• Mimi C Jackson, DC

• Public Health & General Preventive Medicine Physician in Seattle, WA
• Providers in Seattle, WA by specialty
• Public Health & General Preventive Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2009; 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.