Kelly Rose Jackson, WHCNP, CNM

Primary specialty

Advanced Practice MidwifeTaxonomy code 367A00000X

License

10005243 Issued in OR

Practice address

22400 Salamo Rd Ste 201
West Linn, OR 97068-8269

Phone

(503) 723-7234

Fax

(503) 650-4464

NPI assigned

Dec 15, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Kelly Rose Grant Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Certified Nurse Midwife

State licenses

Practice roles

Locations

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.

• MD Squared

  • Medical Specialty Clinic/Center
  • West Linn, OR
  • NPI 1285988444

  Single Specialty

  NPD
• The Jackson Macy Clinic LLC

  • Advanced Practice Midwife
  • Tualatin, OR
  • NPI 1780390864

  Single Specialty

  NPD
• Cynthia Gulick, PC

  • Family Medicine Physician
  • Tigard, OR
  • NPI 1467675009

  Single Specialty

  NPD (past)
• My Other Me

  • Gynecology Physician
  • Portland, OR
  • NPI 1801462080

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1671062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733788800000",
    "number": "1659083129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22400 SALAMO RD STE 201",
            "city": "WEST LINN",
            "state": "OR",
            "postal_code": "970688269",
            "telephone_number": "503-723-7234",
            "fax_number": "503-650-4464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22400 SALAMO RD STE 201",
            "city": "WEST LINN",
            "state": "OR",
            "postal_code": "970688269",
            "telephone_number": "503-723-7234",
            "fax_number": "503-650-4464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KELLY",
        "middle_name": "ROSE",
        "credential": "WHCNP, CNM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-12-15",
        "last_updated": "2024-12-10",
        "certification_date": "2024-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "OR",
            "license": "10002453",
            "primary": false
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Advanced Practice Midwife",
            "state": "OR",
            "license": "10005243",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "GRANT",
            "middle_name": "ROSE",
            "credential": "WHCNP, CNM",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Intermission Massage Studio
• Intuitive Body-Werx
• Anca Mirela Ivan, PSYD
• Badia Jabbour, M.D.
• Brooke Renee Jackson
• James FM Yanney DDS MD
• Janet D Thompson,DC, Chiropractic Physician
• JD Markham Hearing Healthcare Inc.
• Jean M Pacewic DMD PC
• Meghann Jenkins

• Advanced Practice Midwife in West Linn, OR
• Providers in West Linn, OR by specialty
• Advanced Practice Midwife in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2024; 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.