Tamara Dominique Jackson

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

2218 Rhode Island Ave NE
Washington, DC 20018-2827

Phone

(202) 717-9428

NPI assigned

Mar 28, 2023

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1679961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686096000000",
    "number": "1023712726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1367 MASSACHUSETTS AVE SE # 2",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200031540",
            "telephone_number": "202-977-1259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2218 RHODE ISLAND AVE NE",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200182827",
            "telephone_number": "202-717-9428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "TAMARA",
        "middle_name": "DOMINIQUE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-03-28",
        "last_updated": "2023-06-07",
        "certification_date": "2023-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "DC",
            "license": "1023712726",
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Jackson, CACI
• Susan Searle Jackson, RN
• Sydney Jackson
• Taliah Jackson
• Tamara Jackson, PHD
• Tamika Jackson
• Taneeka Jackson, LGSW
• Tara Monique Jackson
• Tawana Ann Jackson
• Tawann Patrice Jackson, D.D.S.

• Case Manager/Care Coordinator in Washington, DC
• Providers in Washington, DC by specialty
• Case Manager/Care Coordinator in District of Columbia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.