Mildred Jean Lee-Jackson, PT

Primary specialty

SpecialistTaxonomy code 174400000X

License

PT0003333 Issued in FL

Practice address

178 Howard St
Niceville, FL 32578-8022

Phone

(850) 678-6436

NPI assigned

Apr 29, 2008

Last updated

Apr 29, 2008By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1209427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209427200000",
    "number": "1780859728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "178 HOWARD ST",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325788022",
            "telephone_number": "850-678-6436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "178 HOWARD ST",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325788022",
            "telephone_number": "850-678-6436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE-JACKSON",
        "first_name": "MILDRED",
        "middle_name": "JEAN",
        "name_prefix": "Ms.",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-04-29",
        "last_updated": "2008-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "FL",
            "license": "PT0003333",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891638100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tammy Lantz, RD, LD
• Tionna Lawrence
• Jennifer Lynn Lay, MD
• Leah Thompson Gagnon, D.M.D, P.a.
• Alaina Lebrun, PT
• Holliday Lee
• Shawn M. Lee, ACNP-BC, FNP
• Shelby Lemley
• B Victoria Monzon Lemond, CRNA
• Lee Lemond Jr.

• Specialist in Niceville, FL
• Providers in Niceville, FL by specialty
• Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 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.