Healthcare Provider Details

I. General information

NPI: 1568621613
Provider Name (Legal Business Name): REBECCA RAIN JACKSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2008
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 BATTLECREEK DR UNIT A
FORT COLLINS CO
80528-5120
US

IV. Provider business mailing address

2118 ESSEX CT
FORT COLLINS CO
80526-1615
US

V. Phone/Fax

Practice location:
  • Phone: 970-568-5810
  • Fax:
Mailing address:
  • Phone: 970-646-8396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number47225
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number47225
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: