Michelley Jackson, RN
Individual provider Active NPI Registered Nurse · Pinon, AZ
NPI 1790967321 · NPPES record last updated Dec 5, 2007
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128b(4) exclusion effective Nov 20, 2017.
Key facts
- NPI
- 1790967321
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- RN149006 (AZ)
- Practice address
- Navajo Route 4 Two Miles East of Pinon
Pinon, AZ 86510 - Phone
- (928) 725-9500
- Fax
- (928) 725-9654
- NPI assigned
- Dec 5, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN149006 | AZ | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN149006 | AZ | Yes |
Addresses
Primary practice location
Navajo Route 4 Two Miles East of Pinon
Pinon, AZ 86510
Mailing address
PO Box PH
Chinle, AZ 86503-8000
Phone (928) 674-7001
Other providers in Pinon, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 5, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- OIG LEIE (HHS Office of Inspector General).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.