Active NPI
Caroline Arden Jackson
- Student in an Organized Health Care Education/Training Program
- Vestavia, AL
National Provider Identifier
1114516010
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 7075 Lake Run Dr
Vestavia, AL 35242-7503 - Phone
- (205) 789-7079
- NPI assigned
- Jan 14, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
7075 Lake Run Dr
Vestavia, AL 35242-7503
Mailing address
7075 Lake Run Dr
Vestavia, AL 35242-7503
Phone (205) 789-7079
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1610582400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610582400000",
"number": "1114516010",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7075 LAKE RUN DR",
"city": "VESTAVIA",
"state": "AL",
"postal_code": "352427503",
"telephone_number": "205-789-7079"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7075 LAKE RUN DR",
"city": "VESTAVIA",
"state": "AL",
"postal_code": "352427503",
"telephone_number": "205-789-7079"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "CAROLINE",
"middle_name": "ARDEN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-01-14",
"last_updated": "2021-01-14",
"certification_date": "2021-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vestavia, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 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.