NPIMap

Organization Active NPI

Dr. Brandie Jackson, LLC

  • Home Health Agency
  • Williamsburg, VA
National Provider Identifier
1073104089
Registry record updated Feb 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
DR. BRANDIE JACKSON, LLC
Practice address
3902 Rochambeau Dr
Williamsburg, VA 23188-6620
Phone
(757) 707-0945
NPI assigned
Feb 1, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2021

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

Authorized official

Name
Dr. Brandie Jackson Tena, DPT, CLTNPI 1396707337
Title
Doctor of Physical Therapy
Phone
(757) 707-0945

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

3902 Rochambeau Dr
Williamsburg, VA 23188-6620

Mailing address

3902 Rochambeau Dr
Williamsburg, VA 23188-6620
Phone (757) 707-0945

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1612137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612137600000",
    "number": "1073104089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3902 ROCHAMBEAU DR",
            "city": "WILLIAMSBURG",
            "state": "VA",
            "postal_code": "231886620",
            "telephone_number": "757-707-0945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3902 ROCHAMBEAU DR",
            "city": "WILLIAMSBURG",
            "state": "VA",
            "postal_code": "231886620",
            "telephone_number": "757-707-0945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. BRANDIE JACKSON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-01",
        "last_updated": "2021-02-01",
        "certification_date": "2021-02-01",
        "status": "A",
        "authorized_official_last_name": "TENA",
        "authorized_official_first_name": "BRANDIE",
        "authorized_official_middle_name": "JACKSON",
        "authorized_official_title_or_position": "DOCTOR OF PHYSICAL THERAPY",
        "authorized_official_telephone_number": "757-707-0945",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPT, CLT"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamsburg, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2021; 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.