Active NPI
Mary Kaitlyn Jackson
- Behavior Analyst
- Jonesboro, AR
National Provider Identifier
1033082144
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 12580290
- Practice address
- 2815 Longview Dr
Jonesboro, AR 72401-5919 - Phone
- (870) 842-3274
- NPI assigned
- Sep 25, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 12580290 | AR | Primary |
Addresses
Primary practice location
2815 Longview Dr
Jonesboro, AR 72401-5919
Mailing address
119 Williamsburg Rd
Walnut Ridge, AR 72476-8477
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 |
|---|---|---|---|
| 12580290 | AR | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1758758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1758758400000",
"number": "1033082144",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "119 WILLIAMSBURG RD",
"city": "WALNUT RIDGE",
"state": "AR",
"postal_code": "724768477"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2815 LONGVIEW DR",
"city": "JONESBORO",
"state": "AR",
"postal_code": "724015919",
"telephone_number": "870-842-3274"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "MARY",
"middle_name": "KAITLYN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-09-25",
"last_updated": "2025-09-25",
"certification_date": "2025-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "AR",
"license": "12580290",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jonesboro, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.