Tennye R Jackson, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

27165 Issued in TN

Practice address

3960 Knight Arnold Rd
Memphis, TN 38118-3035

Phone

(901) 753-7154

Fax

(901) 755-9035

NPI assigned

Oct 4, 2006

Sex

Female

Sole proprietor

Yes

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

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1235224916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3960 KNIGHT ARNOLD RD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381183035",
            "telephone_number": "901-753-7154",
            "fax_number": "901-755-9035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3960 KNIGHT ARNOLD RD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381183035",
            "telephone_number": "901-753-7154",
            "fax_number": "901-755-9035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "TENNYE",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "27165",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Scott Christian Jackson
• Shandrika Jackson, RN
• Shironda D Jackson, LBSW
• Tammara Jackson, DPT
• Tasheka L Jackson
• Toriella Jackson, CPRS
• Treena W Jackson, FNP, MSN
• Trinette Jackson
• Twanna Evette Jackson, APN, BC
• Veronica Jackson, CSW

• Family Medicine Physician in Memphis, TN
• Providers in Memphis, TN by specialty
• Family Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.