Jerri Nixon, LPCC
Individual provider Active NPI Professional Counselor · Jamestown, KY
NPI 1003213836 · NPPES record last updated Sep 1, 2023
Key facts
- NPI
- 1003213836
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 285791 (KY)
- Practice address
- 342 S Main St
Jamestown, KY 42629-2199 - Phone
- (844) 435-0900
- Fax
- (270) 858-4029
- NPI assigned
- Nov 21, 2014
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231205002011 | KY | Practitioner - Mental Health Counselor | 4082062872 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 285791 | KY | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cumberland Family Medical Center Inc | Current |
Accepting new patients | |
| Cumberland Family Medical Center Inc | Current | Accepting new patients | |
| Cumberland Family Medical Center Inc | Current |
Accepting new patients | |
| Lake Cumberland Regional Mental Health Mental Retardation Board, Inc. | Past |
Accepting new patients | |
| Lake Cumberland Regional MHMR Board Outpatient | Past | Accepting new patients |
Locations
360 Keen St
Burkesville, KY 42717
Phone (270) 864-1472
342 S Main St
Jamestown, KY 42629
Phone (270) 343-3966
2258 S Highway 127
Russell Springs, KY 42642
Phone (270) 866-2224
1554 N Highway 127
Russell Springs, KY 42642
Phone (270) 866-3586
2166 S Highway 127
Russell Springs, KY 42642
Phone (270) 866-2224
1409 S Highway 76
Russell Springs, KY 42642
Phone (270) 866-6197
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Case Manager/Care Coordinator | 171M00000X | |||
| Professional Counselor | 101YP2500X | 285791 | KY | Yes |
Addresses
Primary practice location
342 S Main St
Jamestown, KY 42629-2199
Mailing address
PO Box 1080
Burkesville, KY 42717-1080
Phone (270) 858-6655
Other providers in Jamestown, KY
- Jason McNay
- Allison F McQueary
- Tanaya McQueary
- Krista Meece
- Angela M Murray
- Angela A Parnell
- Larry Shawn Phillips
- Lisa Pierce
- Arlie Piercy
- Howard James Popplewell
All providers in Jamestown, KY · Professional Counselor in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 1, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.