Autumn Marie Jackson

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

APS.003224 Issued in OH

Practice address

549 E Front St
Logan, OH 43138-1717

Phone

(740) 407-8697

NPI assigned

Jun 22, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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": "1655856000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655856000000",
    "number": "1053042887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "549 E FRONT ST",
            "city": "LOGAN",
            "state": "OH",
            "postal_code": "431381717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "549 E FRONT ST",
            "city": "LOGAN",
            "state": "OH",
            "postal_code": "431381717",
            "telephone_number": "740-407-8697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "AUTUMN",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-22",
        "last_updated": "2022-06-22",
        "certification_date": "2022-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "OH",
            "license": "APS.003224",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://crm.bestnotes.com/portal/smry",
            "affiliation": "N",
            "endpointDescription": "Portal",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "549 E Front St",
            "city": "Logan",
            "state": "OH",
            "country_code": "US",
            "postal_code": "431381717",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Stacie Hunter, CMA
• Lexie Hyme, RPH TECH
• Sheila A Ingraham, LCDCIII
• Nida Iqbal
• John A Ireton, D.O.
• Laura Jackson, LD
• Bethany Ann Jagers, CNP
• Sierra L John, LSW
• April Lynn Johnson, RPH TECH
• Christopher Johnson

• Peer Specialist in Logan, OH
• Providers in Logan, OH by specialty
• Peer Specialist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 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.

Verify at the official NPI Registry.