1497083851 NPI number — NAMPA CLASSICAL ACADEMY CHARTER SCHOOL

Table of content: WHITNEY ERIKA JACKSON M.D. (NPI 1306088422)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497083851 NPI number — NAMPA CLASSICAL ACADEMY CHARTER SCHOOL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NAMPA CLASSICAL ACADEMY CHARTER SCHOOL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497083851
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1701 SMITH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAMPA
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83651
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-475-2232
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 SMITH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAMPA
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-475-2232
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/24/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LEVESQUE
Authorized Official First Name:
TODD
Authorized Official Middle Name:
Authorized Official Title or Position:
OPERATIONS MANAGER
Authorized Official Telephone Number:
208-922-9300

Provider Taxonomy Codes

  • Taxonomy code: 251300000X , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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