Active NPI
Stephanie Denise Jackson
- Foster Care Agency
- Buckeye, AZ
National Provider Identifier
1003459934
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Foster Care Agency
- License
- 9911474
- Practice address
- 22321 W Morning Glory St
Buckeye, AZ 85326-7181 - Phone
- (503) 209-7572
- Fax
- (602) 455-4624
- NPI assigned
- Oct 23, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Foster Care Agency | 253J00000X | 9911474 | AZ | Primary |
| Child Mental Illness Respite Care | 385HR2055X | 3311474 | AZ |
Addresses
Primary practice location
22321 W Morning Glory St
Buckeye, AZ 85326-7181
Mailing address
22321 W Morning Glory St
Buckeye, AZ 85326-7181
Phone (503) 209-7572
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9911474 | AZ | MD | Foster Care Agency |
| 3311474 | AZ | MD | Child Mental Illness Respite Care |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1571788800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1583798400000",
"number": "1003459934",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22321 W MORNING GLORY ST",
"city": "BUCKEYE",
"state": "AZ",
"postal_code": "853267181",
"telephone_number": "503-209-7572",
"fax_number": "602-455-4624"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22321 W MORNING GLORY ST",
"city": "BUCKEYE",
"state": "AZ",
"postal_code": "853267181",
"telephone_number": "503-209-7572",
"fax_number": "602-455-4624"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "STEPHANIE",
"middle_name": "DENISE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-10-23",
"last_updated": "2020-03-10",
"certification_date": "2020-03-10",
"status": "A"
},
"taxonomies": [
{
"code": "253J00000X",
"taxonomy_group": "",
"desc": "Foster Care Agency",
"state": "AZ",
"license": "9911474",
"primary": true
},
{
"code": "385HR2055X",
"taxonomy_group": "",
"desc": "Respite Care, Respite Care, Mental Illness, Child",
"state": "AZ",
"license": "3311474",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Buckeye, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.