Michael Ben Jackson

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

AP30003880 Issued in WA

Practice address

925 Adele Ave
Bremerton, WA 98312-3521

Phone

(360) 782-0129

Fax

(360) 377-8029

NPI assigned

Aug 31, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

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.

• Healthcare System Services Inc

  dba Olympic Psychiatric & Wellness Center

  • Mental Health Counselor
  • Bremerton, WA
  • NPI 1437330131

  Psychiatric/Mental Health

  NPD (past)
• Jennifer W. Carl, M.D.,PC

  • Physical Medicine & Rehabilitation Physician
  • Bremerton, WA
  • NPI 1245487156
  NPD (past)

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1720199839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 NE LARSON LAKE RD",
            "city": "BELFAIR",
            "state": "WA",
            "postal_code": "985289404",
            "telephone_number": "360-782-0129",
            "fax_number": "360-377-8029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 ADELE AVE",
            "city": "BREMERTON",
            "state": "WA",
            "postal_code": "983123521",
            "telephone_number": "360-782-0129",
            "fax_number": "360-377-8029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MICHAEL",
        "middle_name": "BEN",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP30003880",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brooke Jackson, BS, RVT
• Dana Jackson
• Kathleen Jackson
• Lacey Jean Jackson, PHARMD
• Maria Cecilia Jackson
• Robert Jackson II
• Jeff Jacobson, MA
• Trace Jacquot
• John David Jaeger, AAC
• Manas Jain, MD

• Psychiatric/Mental Health Nurse Practitioner in Bremerton, WA
• Providers in Bremerton, WA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.