Breonka Marie Jackson

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

615 Baronne St Ste 304
New Orleans, LA 70113

Phone

(504) 814-8001

NPI assigned

Apr 5, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Creed Group of Louisiana LLC

  • Community/Behavioral Health Agency
  • New Orleans, LA
  • NPI 1922512326
  NPD (past)

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

{
    "created_epoch": "1459814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562025600000",
    "number": "1053774158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5220 FOREST PARK LN",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701318583",
            "telephone_number": "504-215-9094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 BARONNE ST STE 304",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "70113",
            "telephone_number": "504-814-8001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "BREONKA",
        "middle_name": "MARIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-04-05",
        "last_updated": "2019-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jackson Hands of Change
• Tamara Jackson-Snowden, MSW, LCSW,MBA, CA
• Maga E Jackson-Triche, M.D.
• Amanda Ann Brown Jackson, MD
• Ami Rynae Jackson, CRNP
• Cadence Diane Jackson, N/A
• Chiquita Tanell Jackson
• Courtney Carol Jackson, M.D.
• Crystal Jackson
• Cyrena Brown Jackson, PHARM D

• Case Manager/Care Coordinator in New Orleans, LA
• Providers in New Orleans, LA by specialty
• Case Manager/Care Coordinator in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2019; 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.