Jacqueline Rene Maxson, LVN

Primary specialty

Licensed Vocational NurseTaxonomy code 164X00000X

License

234891 Issued in CA

Practice address

1330 N Indian Canyon Dr Ste a
Palm Springs, CA 92262-4880

Phone

(760) 322-9065

NPI assigned

Oct 3, 2018

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 names 1

• Jackie Rene Maxson Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• WCHS Inc.

  • Methadone Clinic
  • Palm Springs, CA
  • NPI 1215947775
  NPD (past)

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

{
    "created_epoch": "1538524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538524800000",
    "number": "1730664939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1330 N INDIAN CANYON DR STE A",
            "city": "PALM SPRINGS",
            "state": "CA",
            "postal_code": "922624880",
            "telephone_number": "760-322-9065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1330 N INDIAN CANYON DR STE A",
            "city": "PALM SPRINGS",
            "state": "CA",
            "postal_code": "922624880",
            "telephone_number": "760-322-9065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAXSON",
        "first_name": "JACQUELINE",
        "middle_name": "RENE",
        "credential": "LVN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-03",
        "last_updated": "2018-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "234891",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACKIE",
            "last_name": "MAXSON",
            "middle_name": "RENE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Bony Mathew, FNP-BC
• Marlon Stephen Mathews, MD
• Matthew Welebir DDS Inc
• Ashly Maughan
• Kirby Maus, LMFT
• Steven H May, PHD
• Brenna C Mayhew, RPH
• Nancy Ann Mazur, N.D.
• Carolyn McAlpin, N.P.
• Lynette Lipp McBride, PA-C

• Licensed Vocational Nurse in Palm Springs, CA
• Providers in Palm Springs, CA by specialty
• Licensed Vocational Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2018; 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.