MEDICARE: MR. JOHNATHAN JACKSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN152086	LA

General Provider Information

NPI Number	:	1730041070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHNATHAN JACKSON

Provider Business Mailing Address
First Line	:	2001 OXFORD PL
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-5503
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 OXFORD PL
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-5503
Country	:	US
Telephone Number	:	318-780-3367
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/25/2025
Last Update Date	:	11/25/2025

Similar Medicare Providers

1316124860 — DJ ALEX REHABILITATIVE CARE LLC
Practice Location Address:

2010 OXFORD PL
BOSSIER CITY, LA
71111-5503

Practice Phone: 318-221-2535
Practice Fax:

1104102045 — BRANDI RAE STINSON
Practice Location Address:

5725 RUNWAY RD
OKLAHOMA CITY, OK
73135-5503

Practice Phone: 405-651-4081
Practice Fax:

1568898799 — JANICE ANN NEUBAUER ARNP, MSN
Practice Location Address:

5503 SW 89TH AVE
COOPER CITY, FL
33328-5155

Practice Phone: 954-830-6849
Practice Fax:

1316484793 — MARY JANE GUERRERO NP
Practice Location Address:

11257 RUDMAN DR
CULVER CITY, CA
90230-5503

Practice Phone: 714-318-4579
Practice Fax:

1891216081 — PHASE ZERO THERAPY
Practice Location Address:

206 E 11TH ST
SILVER CITY, NM
88061-5503

Practice Phone: 575-202-2713
Practice Fax:

1861054298 — MARIE C. WEIL, PSYD, LLC
Practice Location Address:

206 E 11TH ST
SILVER CITY, NM
88061-5503

Practice Phone: 575-342-1236
Practice Fax:

Directions to “ MR. JOHNATHAN JACKSON ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.