NPIMap

Organization Active NPI

Melinda Jackson MD PHD

  • Family Medicine Physician
  • Newburgh, IN
National Provider Identifier
1700064797
Registry record updated Feb 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
01037696A Issued in IN
Legal business name
MELINDA JACKSON MD PHD
Practice address
4144 Wyntree Dr
Newburgh, IN 47630-2521
Phone
(812) 858-1957
Fax
(812) 858-1917
NPI assigned
Feb 1, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2008

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

Authorized official

Name
Dr. Melinda Brown Jackson, MD,PHDNPI 1558332734
Title
Owner/Physician
Phone
(812) 858-1957

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 01037696A IN Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X 71002200A IN

Addresses

Primary practice location

4144 Wyntree Dr
Newburgh, IN 47630-2521

Mailing address

4144 Wyntree Dr
Newburgh, IN 47630-2521
Phone (812) 858-1957

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1201824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201824000000",
    "number": "1700064797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4144 WYNTREE DR",
            "city": "NEWBURGH",
            "state": "IN",
            "postal_code": "476302521",
            "telephone_number": "812-858-1957",
            "fax_number": "812-858-1917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4144 WYNTREE DR",
            "city": "NEWBURGH",
            "state": "IN",
            "postal_code": "476302521",
            "telephone_number": "812-858-1957",
            "fax_number": "812-858-1917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MELINDA JACKSON MD PHD",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-01",
        "last_updated": "2008-02-01",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "MELINDA",
        "authorized_official_middle_name": "BROWN",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "812-858-1957",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD,PHD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01037696A",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71002200A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newburgh, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2008; 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.