NPI 1467922856 · live from the CMS NPI Registry
Michael David Jackson
Registered Nurse, Psych/Mental Health in Woodburn, OR. National Provider Identifier 1467922856, active.
NPI record
| NPI | 1467922856 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Registered Nurse, Psych/Mental Health 163WP0808X |
| Practice location | 1605 E Lincoln Rd, Woodburn, OR 97071 |
| Practice phone | 503-982-9300 |
| Mailing address | 2045 Silverton Rd Ne, Salem, OR 97301 |
| Enumerated | November 28, 2018 |
| Last updated | January 8, 2025 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Registered Nurse, Psych/Mental Health, Adult | 163WP0809X | 201401353RN (OR) |
| Registered Nurse, Psych/Mental Health primary | 163WP0808X | 201401353RN (OR) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.