Kim Jackson, PHD

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

3330 Artic Blvd Ste 101
Anchorage, AK 99503-4580

Phone

(907) 600-3425

NPI assigned

Nov 23, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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 and National Provider Directory roles.

• Michelle R Simmons, LPC, LLC

  • Community/Behavioral Health Agency
  • Westminster, CO
  • NPI 1093268377
  Medicare reassignment NPD
• Michelle R Simmons, LPC, LLC

  • Community/Behavioral Health Agency
  • Aurora, CO
  • NPI 1538042973
  NPD (past)

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

{
    "created_epoch": "1479859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664150400000",
    "number": "1285177261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 CORDOVA ST STE 101",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995032745",
            "telephone_number": "907-279-9640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3330 ARTIC BLVD STE 101",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995034580",
            "telephone_number": "907-600-3425"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8012 Stewart Mountain Dr",
            "address_purpose": "LOCATION",
            "city": "Eagle River",
            "state": "AK",
            "postal_code": "995779013",
            "country_code": "US",
            "telephone_number": "907-694-3336",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2600 Cordova St Ste 101",
            "address_purpose": "LOCATION",
            "city": "Anchorage",
            "state": "AK",
            "postal_code": "995032745",
            "country_code": "US",
            "telephone_number": "907-279-9640",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KIM",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-23",
        "last_updated": "2022-09-26",
        "certification_date": "2022-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": "AK",
            "license": "1044974",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jayly Jermayne Jackson
• Jerline Jackson
• Kendal Jackson
• Kiara Jackson
• Kilee Brooke Jackson
• Laurie Rene Jackson, M.S.
• Lisa M Jackson, ANP
• Maureen Annette Jackson
• Nicole Jackson
• Rae Jackson

• Mental Health Counselor in Anchorage, AK
• Providers in Anchorage, AK by specialty
• Mental Health Counselor in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2022; 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.