Nyles Antony Jackson, MSW, APSW, SAC-IT

Primary specialty

Social WorkerTaxonomy code 104100000X

License

128033-121 Issued in WI

Practice address

4109 67TH St
Kenosha, WI 53142-3836

Phone

(262) 652-9830

Fax

(262) 652-2931

NPI assigned

Apr 7, 2010

Last updated

Apr 7, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2009

Medicare assignment

May accept Medicare assignment

Group practices

Oakwood Clinical Associates, LTDGroup PAC ID 8022084383, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Oakwood Clinical Associates, LTD

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Kenosha, WI
  • NPI 1447289434

  Addiction (Substance Use Disorder)

  Medicare reassignment Care Compare group NPD
• Noble Journey LLC

  • Clinical Social Worker
  • Kenosha, WI
  • NPI 1477413672
  NPD Authorized official
• Cleanslate Medical Group of Wisconsin, SC

  • Addiction Medicine (Internal Medicine) Physician
  • Glendale, WI
  • NPI 1518404854
  NPD (past)

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

{
    "created_epoch": "1270598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1270598400000",
    "number": "1053637629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4109 67TH ST",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531423836",
            "telephone_number": "262-652-9830",
            "fax_number": "262-652-2931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4109 67TH ST",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531423836",
            "telephone_number": "262-652-9830",
            "fax_number": "262-652-2931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "NYLES",
        "middle_name": "ANTONY",
        "name_prefix": "Mr.",
        "credential": "MSW, APSW, SAC-IT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-04-07",
        "last_updated": "2010-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "15877-130",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "WI",
            "license": "128033-121",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jenell Diane Jackley, CPNP
• Christopher D. Jackson, LPC
• Danielle Marie Jackson, LPC
• Glenda Elizabeth Jackson, R.N.
• Leeann G Jackson, LPC
• Michael A Jacobs, PA-C
• Amy Lynn Jacobson, P.T.
• Kerry Jacquet, PT, DPT
• Kathryn Ann Jaffray, PTA
• Arif G Jaka, MD

• Social Worker in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Social Worker in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.