Healthcare Provider Details

I. General information

NPI: 1114514239
Provider Name (Legal Business Name): HAYDEN JACKSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2020
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7710 MERCY RD
OMAHA NE
68124-2372
US

IV. Provider business mailing address

7710 MERCY RD STE 202
OMAHA NE
68124-2353
US

V. Phone/Fax

Practice location:
  • Phone: 402-280-4677
  • Fax: 402-280-1237
Mailing address:
  • Phone: 402-280-4792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number1114514239
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number10075
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: