Larry Randolph Jackson, REGISTERED NURSE

Primary specialty

Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0808X

License

56879 Issued in SC

Practice address

615 Rapids Rd
Columbia, SC 29212-3024

Phone

(803) 798-2211

NPI assigned

Dec 19, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mr. Larry Randolph Jackson Professional name

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": "1166486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1093878191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 RAPIDS RD",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292123024",
            "telephone_number": "803-798-2211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 RAPIDS RD",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292123024",
            "telephone_number": "803-798-2211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "LARRY",
        "middle_name": "RANDOLPH",
        "name_prefix": "Mr.",
        "credential": "REGISTERED NURSE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "SC",
            "license": "56879",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LARRY",
            "last_name": "JACKSON",
            "middle_name": "RANDOLPH",
            "prefix": "MR.",
            "credential": "REGISTERED NURSE",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Karen Jackson, APRN
• Kathy Melton Jackson, R.N.
• Kayla Mackenzie Jackson, PTA
• Kyliah Laneice Jackson, LISW-CP
• Laquanda Jackson
• Latonya Demetria Jackson, CAC II
• Latoya S Jackson, PTA
• Laura B Jackson, MD
• Lesa Diane Jackson, MSW
• Marcelina Jackson

• Psychiatric/Mental Health Registered Nurse in Columbia, SC
• Providers in Columbia, SC by specialty
• Psychiatric/Mental Health Registered Nurse in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.