Laticia S Jackson

Primary specialty

Non-emergency Medical Transport (VAN)Taxonomy code 343900000X

License

RR641726 Issued in OH

Practice address

4118 Annapolis Ave
Dayton, OH 45416-1505

Phone

(937) 248-9741

NPI assigned

Sep 20, 2022

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

Other identifiers 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": "1663632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663632000000",
    "number": "1073236550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4118 ANNAPOLIS AVE",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454161505",
            "telephone_number": "937-248-9741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4118 ANNAPOLIS AVE",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454161505",
            "telephone_number": "937-248-9741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "LATICIA",
        "middle_name": "S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-09-20",
        "last_updated": "2022-09-20",
        "certification_date": "2022-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "OH",
            "license": "RR641726",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0498434",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kenneth Jackson
• Kymberly Jackson
• Ladazia Jackson
• Laquisha Lachelle Jackson, REGISTERED NURSE
• Latania Jackson, CASE MANAGER
• Melinda Jackson
• Monica Jackson, PH.D.
• Nichoal Jackson
• Nicole R Jackson, CNP, ACNP-BC
• Nikkita T Jackson, LISW

• Non-emergency Medical Transport (VAN) in Dayton, OH
• Providers in Dayton, OH by specialty
• Non-emergency Medical Transport (VAN) in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 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.