Active NPI
Keimari Christine Jackson
- Social Worker
- Schenectady, NY
National Provider Identifier
1114897501
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 128679-01
- Practice address
- 122 Park Ave
Schenectady, NY 12304-1628 - Phone
- (518) 948-4364
- NPI assigned
- Nov 10, 2025
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 128679-01 | NY | Primary |
Addresses
Primary practice location
122 Park Ave
Schenectady, NY 12304-1628
Mailing address
122 Park Ave
Schenectady, NY 12304-1628
Phone (518) 948-4364
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 128679-01 | NY | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1762732800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1762732800000",
"number": "1114897501",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "122 PARK AVE",
"city": "SCHENECTADY",
"state": "NY",
"postal_code": "123041628",
"telephone_number": "518-948-4364"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "122 PARK AVE",
"city": "SCHENECTADY",
"state": "NY",
"postal_code": "123041628",
"telephone_number": "518-948-4364"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "KEIMARI",
"middle_name": "CHRISTINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-11-10",
"last_updated": "2025-11-10",
"certification_date": "2025-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "128679-01",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Schenectady, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.