Active NPI
Tamara Jean Jackson, LMT
- Community Health Worker
- Wewahitchka, FL
National Provider Identifier
1043542236
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- MA36032
- Practice address
- 350 Henry Ave
Wewahitchka, FL 32465-8766 - Phone
- (850) 639-6211
- NPI assigned
- Feb 12, 2010
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | MA36032 | FL | Primary |
Addresses
Primary practice location
350 Henry Ave
Wewahitchka, FL 32465-8766
Mailing address
350 Henry Ave
Wewahitchka, FL 32465-8766
Phone (850) 639-6211
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 |
|---|---|---|---|
| MA36032 | FL | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1265932800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1265932800000",
"number": "1043542236",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "350 HENRY AVE",
"city": "WEWAHITCHKA",
"state": "FL",
"postal_code": "324658766",
"telephone_number": "850-639-6211"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "350 HENRY AVE",
"city": "WEWAHITCHKA",
"state": "FL",
"postal_code": "324658766",
"telephone_number": "850-639-6211"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "TAMARA",
"middle_name": "JEAN",
"name_prefix": "Mrs.",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-02-12",
"last_updated": "2010-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "FL",
"license": "MA36032",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wewahitchka, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.