Active NPI
Kathleen Ann Jackson
- Peer Specialist
- Klamath Falls, OR
National Provider Identifier
1255040937
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- Practice address
- 3206 Onyx Ave
Klamath Falls, OR 97603-7279 - Phone
- (541) 363-1277
- NPI assigned
- Nov 21, 2022
- 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 |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | Primary |
Addresses
Primary practice location
3206 Onyx Ave
Klamath Falls, OR 97603-7279
Mailing address
3206 Onyx Ave
Klamath Falls, OR 97603-7279
Phone (541) 363-1277
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| THW000106149 | Other | OR | OHA |
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": "1668988800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1668988800000",
"number": "1255040937",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3206 ONYX AVE",
"city": "KLAMATH FALLS",
"state": "OR",
"postal_code": "976037279",
"telephone_number": "541-363-1277"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3206 ONYX AVE",
"city": "KLAMATH FALLS",
"state": "OR",
"postal_code": "976037279",
"telephone_number": "541-363-1277"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "KATHLEEN",
"middle_name": "ANN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-11-21",
"last_updated": "2022-11-21",
"certification_date": "2022-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OHA",
"identifier": "THW000106149",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Klamath Falls, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.