Alexis R Jackson

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

PTA29421 Issued in FL

Practice address

11391 Square St Unit 2312
Jacksonville, FL 32256-4099

Phone

(404) 558-7348

NPI assigned

Sep 17, 2024

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

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

{
    "created_epoch": "1726531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726531200000",
    "number": "1124855754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11391 SQUARE ST UNIT 6114",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322564123",
            "telephone_number": "404-558-7348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11391 SQUARE ST UNIT 2312",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322564099",
            "telephone_number": "404-558-7348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ALEXIS",
        "middle_name": "R",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-17",
        "last_updated": "2024-09-17",
        "certification_date": "2024-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "FL",
            "license": "PTA29421",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Willie Jackson II
• Samantha Jackson-Oates
• Mackenzie D Jackson-Ruth, PT
• Adrianne Jackson
• Alexandra Jackson
• Ameera Jackson
• Antoinique Jackson
• Arnitra N Jackson
• Arshea Jackson
• Ashley Jackson

• Physical Medicine & Rehabilitation Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Physical Medicine & Rehabilitation Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2024; 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.