Lateshia Jackson

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

R193593 Issued in MD

Practice address

8737 Brooks Dr Ste 108
Easton, MD 21601-7474

Phone

(800) 867-2395

Fax

(410) 443-4960

NPI assigned

Oct 24, 2013

Last updated

Sep 18, 2019By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in MD

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Arundel Lodge, Inc.

  • Community/Behavioral Health Agency
  • Edgewater, MD
  • NPI 1225213507
  Medicare reassignment NPD
• Upper Bay Counseling & Support Services, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Elkton, MD
  • NPI 1316912652
  Medicare reassignment NPD
• Transformational Telepsychiatry

  • Psychiatric/Mental Health Nurse Practitioner
  • Pikesville, MD
  • NPI 1427531532
  NPD Authorized official
• Transformational Telepsychiatry

  • Psychiatric/Mental Health Nurse Practitioner
  • Pikesville, MD
  • NPI 1548737232
  NPD Authorized official
• Arundel Lodge, Inc

  • Community/Behavioral Health Agency
  • Annapolis, MD
  • NPI 1689063059
  NPD
• Upper Bay Counseling and Support Services, Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Havre de Grace, MD
  • NPI 1114252020
  NPD
• Lifes Energy Wellness Center Inc.

  • Community/Behavioral Health Agency
  • Salisbury, MD
  • NPI 1528726460
  NPD (past)
• Lifes Energy Wellness Center Inc.

  • Community/Behavioral Health Agency
  • Salisbury, MD
  • NPI 1912579822
  NPD (past)

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

{
    "created_epoch": "1382572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568764800000",
    "number": "1063840262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8142 HAROLD CT",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210614960",
            "telephone_number": "202-253-3588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8737 BROOKS DR STE 108",
            "city": "EASTON",
            "state": "MD",
            "postal_code": "216017474",
            "telephone_number": "800-867-2395",
            "fax_number": "410-443-4960"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "505 E Main St",
            "address_purpose": "LOCATION",
            "city": "Salisbury",
            "state": "MD",
            "postal_code": "218045020",
            "country_code": "US",
            "telephone_number": "410-341-3420",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8142 Harold Ct",
            "address_purpose": "LOCATION",
            "city": "Glen Burnie",
            "state": "MD",
            "postal_code": "21061",
            "country_code": "US",
            "telephone_number": "202-253-3588",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2324 West Zion Road Suite 112",
            "address_2": "Suite 112",
            "address_purpose": "LOCATION",
            "city": "Salisbury",
            "state": "MD",
            "postal_code": "21801",
            "country_code": "US",
            "telephone_number": "800-867-2395",
            "fax_number": "410-443-0842",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "514 Poplar St",
            "address_purpose": "LOCATION",
            "city": "Cambridge",
            "state": "MD",
            "postal_code": "216131834",
            "country_code": "US",
            "telephone_number": "800-867-2395",
            "fax_number": "410-443-0842",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "200 Booth St",
            "address_purpose": "LOCATION",
            "city": "Elkton",
            "state": "MD",
            "postal_code": "219215657",
            "country_code": "US",
            "telephone_number": "410-996-3400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "LATESHIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-10-24",
        "last_updated": "2019-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R193593",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Interplay Occupational Therapy LLC
• Holly Raina Ireland, LGSW
• Diane Irven, CAC-AD
• J Fredrick Heaton DMD PA
• Daphime Jackson, CSC-AD
• Mia Jackson, LGPC
• Sally Dale G Jafari, CRNP
• James & Dyer, M.D.,P.a.
• James P Thompson MD PA (Midshore Surgical Eye Center)
• James P Thompson MD PA

• Psychiatric/Mental Health Nurse Practitioner in Easton, MD
• Providers in Easton, MD by specialty
• Psychiatric/Mental Health Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.