Jackie Lynette Roberson

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OT.0005855 Issued in CO

Practice address

3727 Parker Blvd
Pueblo, CO 81008-2218

Phone

(719) 585-3400

NPI assigned

Feb 26, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Jackie Lynette Tijerina Former name

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.

• Wsi

  • Nursing Care Agency
  • Colorado Springs, CO
  • NPI 1023317385
  NPD (past)

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

{
    "created_epoch": "1551139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577404800000",
    "number": "1114484110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5302 ARTISTIC CIR",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809172212",
            "telephone_number": "512-567-9565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3727 PARKER BLVD",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810082218",
            "telephone_number": "719-585-3400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8540 Scarborough Dr Ste 200",
            "address_purpose": "LOCATION",
            "city": "Colorado Springs",
            "state": "CO",
            "postal_code": "809207513",
            "country_code": "US",
            "telephone_number": "719-630-7500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROBERSON",
        "first_name": "JACKIE",
        "middle_name": "LYNETTE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-26",
        "last_updated": "2019-12-27",
        "certification_date": "2019-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "227900000X",
            "taxonomy_group": "",
            "desc": "Respiratory Therapist, Registered",
            "state": "CO",
            "license": "RTL.0005892",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "CO",
            "license": "OT.0005855",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACKIE",
            "last_name": "TIJERINA",
            "middle_name": "LYNETTE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kasey Taehoon Ro, DPT
• Terry R Roach, CRNA
• Sarah Kate Roark, RN,MSNL, ACAGNP-BC
• Brenda D Robb
• Jonne A Robbins, DENTAL ASSISTANT
• Robert B Goos
• Robert K Browder Inc
• Robert L Drake MD
• Andrew B. Roberts, M.D.
• Brad Alan Roberts, M.D.

• All providers in Pueblo, CO
• Occupational Therapist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2019; 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.