Individual provider Active NPI

Kathryn Vivian Jackson

  • Student in an Organized Health Care Education/Training Program
  • Denver, CO
National Provider Identifier
1235036773
Registry record updated Oct 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
License
IN.0002010268 Issued in CO
Practice address
3333 Regis Blvd
Denver, CO 80221-1154
Phone
(773) 954-5645
NPI assigned
Oct 20, 2026
Last updated
Oct 20, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X IN.0002010268 CO Primary

Addresses

Primary practice location

3333 Regis Blvd
Denver, CO 80221-1154

Mailing address

3333 Regis Blvd
Denver, CO 80221-1154

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": "1792454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1792454400000",
    "number": "1235036773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3333 REGIS BLVD",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802211154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 REGIS BLVD",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802211154",
            "telephone_number": "773-954-5645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KATHRYN",
        "middle_name": "VIVIAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-10-20",
        "last_updated": "2026-10-20",
        "certification_date": "2026-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CO",
            "license": "IN.0002010268",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Denver, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2026; 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.