Jacksie Short, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2018013954 Issued in MO

Practice address

2819 E 29TH St
Joplin, MO 64804

Phone

(417) 781-5530

NPI assigned

Jul 13, 2017

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

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": "1499904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530748800000",
    "number": "1790207546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2819 E 29TH ST",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648049951",
            "telephone_number": "417-781-5530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2819 E 29TH ST",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "64804",
            "telephone_number": "417-781-5530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHORT",
        "first_name": "JACKSIE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-13",
        "last_updated": "2018-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2018013954",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shoal Creek Foot and Ankle Center LLC
• Shoal Creek Foot and Ankle Center LLC
• Carson Slade Shockley
• Desiree Shofler
• Arthur Bernard Short, DDS
• Show Me Supports, LLC
• Viridiana Showalter, RDH
• Randie Shrum
• Arnesh Shukla
• Gretchen Denise Shull, M.D.

• General Practice Dentistry in Joplin, MO
• Providers in Joplin, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 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.