Provider Demographics
NPI:1598554479
Name:JACKSON, JOHN M JR
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:JACKSON
Suffix:JR
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2507 CALDWELL ST APT 250
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-4603
Mailing Address - Country:US
Mailing Address - Phone:402-813-5463
Mailing Address - Fax:
Practice Address - Street 1:2507 CALDWELL ST APT 250
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-4603
Practice Address - Country:US
Practice Address - Phone:402-813-5463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider