Kimberly Nicole Jackson, LBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

0133001314 Issued in VA

Practice address

27018 Lee Hwy
Abingdon, VA 24211-7512

Phone

(276) 525-4460

NPI assigned

Apr 30, 2019

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mount Rogers Community Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Wytheville, VA
  • NPI 1255365599
  NPD (past)

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

{
    "created_epoch": "1556582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605571200000",
    "number": "1104480615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27018 LEE HWY",
            "city": "ABINGDON",
            "state": "VA",
            "postal_code": "242117512",
            "telephone_number": "276-525-4460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27018 LEE HWY",
            "city": "ABINGDON",
            "state": "VA",
            "postal_code": "242117512",
            "telephone_number": "276-525-4460"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "540 W Main St",
            "address_purpose": "LOCATION",
            "city": "Wytheville",
            "state": "VA",
            "postal_code": "243822209",
            "country_code": "US",
            "telephone_number": "276-223-3291",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KIMBERLY",
        "middle_name": "NICOLE",
        "credential": "LBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-30",
        "last_updated": "2020-11-17",
        "certification_date": "2020-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "VA",
            "license": "0133001314",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Innovative Medical Solutions
• Intercept Youth Services Inc
• Mena G Issa, MD
• J&D Pharmacy Inc
• Ashley Justine Jackson, DBH, LMFT, CCTP-II
• Patricia Ann Jackson, L.C.S.W
• Nitin Jain
• James Edward Grau Jr
• Dana Conley James, OTR
• Melissa Lynn Jarrell, MS, CCC-SLP

• Behavior Analyst in Abingdon, VA
• Providers in Abingdon, VA by specialty
• Behavior Analyst in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2020; 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.