Provider Demographics
NPI:1114724176
Name:JACKSON, DESEAN MICHAEL I (DMJ)
Entity type:Individual
Prefix:MR
First Name:DESEAN
Middle Name:MICHAEL
Last Name:JACKSON
Suffix:I
Gender:
Credentials:DMJ
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NE
Mailing Address - Zip Code:69044-1824
Mailing Address - Country:US
Mailing Address - Phone:316-925-1895
Mailing Address - Fax:
Practice Address - Street 1:510 E 2ND ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NE
Practice Address - Zip Code:69044-1817
Practice Address - Country:US
Practice Address - Phone:308-340-3106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion