Active NPI
Chris G Jackson, COTA
- Community Health Worker
- Irving, TX
National Provider Identifier
1124366497
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- 209724
- Practice address
- 6191 N State Highway 161 Ste 650
Irving, TX 75038-2250 - Phone
- (972) 812-3299
- NPI assigned
- Jan 22, 2013
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | 209724 | TX | Primary |
Addresses
Primary practice location
6191 N State Highway 161 Ste 650
Irving, TX 75038-2250
Mailing address
2715 Columbus
Grand Prairie, TX 75054-5512
Phone (682) 365-2442
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 |
|---|---|---|---|
| 209724 | TX | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1358812800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1358812800000",
"number": "1124366497",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2715 COLUMBUS",
"city": "GRAND PRAIRIE",
"state": "TX",
"postal_code": "750545512",
"telephone_number": "682-365-2442"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6191 N STATE HIGHWAY 161 STE 650",
"city": "IRVING",
"state": "TX",
"postal_code": "750382250",
"telephone_number": "972-812-3299"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "CHRIS",
"middle_name": "G",
"name_prefix": "Mr.",
"credential": "COTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-01-22",
"last_updated": "2013-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "TX",
"license": "209724",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Irving, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.