Provider Demographics
NPI:1952108508
Name:JACKSON, DARNELL JR
Entity type:Individual
Prefix:
First Name:DARNELL
Middle Name:
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 1:1719 N 32ND ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68111-4224
Mailing Address - Country:US
Mailing Address - Phone:402-346-6164
Mailing Address - Fax:402-346-6928
Practice Address - Street 1:1905 HARNEY ST STE 703
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-2366
Practice Address - Country:US
Practice Address - Phone:402-346-6164
Practice Address - Fax:402-346-6928
Is Sole Proprietor?:No
Enumeration Date:2025-02-28
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide