Michelley Jackson, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

RN149006 Issued in 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

Last updated

Dec 5, 2007By the provider in NPPES

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)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1196812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196812800000",
    "number": "1790967321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX PH",
            "city": "CHINLE",
            "state": "AZ",
            "postal_code": "865038000",
            "telephone_number": "928-674-7001",
            "fax_number": "928-674-7705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "NAVAJO ROUTE 4 TWO MILES EAST OF PINON",
            "city": "PINON",
            "state": "AZ",
            "postal_code": "86510",
            "telephone_number": "928-725-9500",
            "fax_number": "928-725-9654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MICHELLEY",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-12-05",
        "last_updated": "2007-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AZ",
            "license": "RN149006",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alice F. Hatch, M.D.
• Jane Heavilin, RN
• Lauren Kelli Houston, PHARMD
• Madelene Howard, RN
• David A. Jackson, M.D.
• Laverne James
• Daniel R Johnson, RDN, LDN, CEP
• Karen Frieda Kilman, PT
• Megan S Klingler, RN
• Jeffrey Lawrence, PT

• Registered Nurse in Pinon, AZ
• Providers in Pinon, AZ by specialty
• Registered Nurse in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.