Provider Demographics
NPI:1245100825
Name:JACKSON, DAKOTA NOEL
Entity type:Individual
Prefix:
First Name:DAKOTA
Middle Name:NOEL
Last Name:JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 COLUMBINE CT APT 2
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-5573
Mailing Address - Country:US
Mailing Address - Phone:513-560-2623
Mailing Address - Fax:513-560-2623
Practice Address - Street 1:2 COLUMBINE CT APT 2
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-5573
Practice Address - Country:US
Practice Address - Phone:513-560-2623
Practice Address - Fax:513-560-2623
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-07
Last Update Date:2025-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty