Tammara Jackson, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

12169 Issued in TN

Practice address

3385 Airways Blvd Ste 219
Memphis, TN 38116-3808

Phone

(901) 205-9534

Fax

(833) 471-4041

NPI assigned

Sep 11, 2019

Last updated

Sep 29, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Triumph Agility Care, LLC

  • Family Nurse Practitioner
  • Memphis, TN
  • NPI 1033832514

  Physical Therapist

  NPD

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

{
    "created_epoch": "1568160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695945600000",
    "number": "1255981296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6815 AUTUMNHILL LN",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381351646",
            "telephone_number": "901-315-5803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3385 AIRWAYS BLVD STE 219",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381163808",
            "telephone_number": "901-205-9534",
            "fax_number": "833-471-4041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "TAMMARA",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-09-11",
        "last_updated": "2023-09-29",
        "certification_date": "2023-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MS",
            "license": "6595",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TN",
            "license": "12169",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ricky Jackson
• Ruth Jackson, APN
• Scott Christian Jackson
• Shandrika Jackson, RN
• Shironda D Jackson, LBSW
• Tasheka L Jackson
• Tennye R Jackson, MD
• Toriella Jackson, CPRS
• Treena W Jackson, FNP, MSN
• Trinette Jackson

• Physical Therapist in Memphis, TN
• Providers in Memphis, TN by specialty
• Physical Therapist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.