Active NPI
Lisa Jackson
- Nursing Home Administrator
- Fresno, CA
National Provider Identifier
1053029017
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nursing Home Administrator
- Practice address
- 8050 N Palm Ave Ste 300
Fresno, CA 93711-5510 - Phone
- (866) 981-0656
- Fax
- (866) 571-5484
- NPI assigned
- Nov 9, 2022
- 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 |
|---|---|---|---|---|
| Nursing Home Administrator | 376G00000X | CA | Primary |
Addresses
Primary practice location
8050 N Palm Ave Ste 300
Fresno, CA 93711-5510
Mailing address
8050 N Palm Ave Ste 300
Fresno, CA 93711-5510
Phone (866) 981-0656
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Psyco Kulture, LLC | Current | Accepting new patients |
Locations
8050 N Palm Ave
Ste 300
Fresno, CA 93711
Phone (559) 272-4110
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Transportation Broker
- Fresno, CA
- NPI 1013634294
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1667952000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1667952000000",
"number": "1053029017",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8050 N PALM AVE STE 300",
"city": "FRESNO",
"state": "CA",
"postal_code": "937115510",
"telephone_number": "866-981-0656",
"fax_number": "866-571-5484"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8050 N PALM AVE STE 300",
"city": "FRESNO",
"state": "CA",
"postal_code": "937115510",
"telephone_number": "866-981-0656",
"fax_number": "866-571-5484"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "LISA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-11-09",
"last_updated": "2022-11-09",
"certification_date": "2022-11-09",
"status": "A"
},
"taxonomies": [
{
"code": "376G00000X",
"taxonomy_group": "",
"desc": "Nursing Home Administrator",
"state": "CA",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fresno, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.