Jermal Jackson, RRT

Primary specialty

Critical Care Registered Respiratory TherapistTaxonomy code 2279C0205X

Practice address

Corner of Routes N12 & N7
Fort Defiance, AZ 86504

Phone

(928) 729-8000

NPI assigned

Jul 6, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1657065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657065600000",
    "number": "1760115992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8226 MENAUL BLVD NE # 556",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871104614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CORNER OF ROUTES N12 & N7",
            "city": "FORT DEFIANCE",
            "state": "AZ",
            "postal_code": "86504",
            "telephone_number": "928-729-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JERMAL",
        "credential": "RRT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-07-06",
        "last_updated": "2022-07-06",
        "certification_date": "2022-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2279P3900X",
            "taxonomy_group": "",
            "desc": "Respiratory Therapist, Registered, Neonatal/Pediatrics",
            "state": "NM",
            "license": null,
            "primary": false
        },
        {
            "code": "2279C0205X",
            "taxonomy_group": "",
            "desc": "Respiratory Therapist, Registered, Critical Care",
            "state": "NM",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristoffer D Hunter
• Daniel J Huyser, LPC
• Michael Ihsaan, MD MPH
• Heather Ayn Indelicato, PSY.D
• Dexter P Inniss, D.M.D
• Kathryn Elizabeth Jacques, MPT
• Jacquelyn James, CRNA
• Lilia Janzen-Trotsyuk
• Gregory Jarrin, MD
• Michael R. Jarvis, D.O.

• Critical Care Registered Respiratory Therapist in Fort Defiance, AZ
• Providers in Fort Defiance, AZ by specialty
• Critical Care Registered Respiratory Therapist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2022; 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.