Active NPI
Kitarshyi Muldrow Jackson, PT
- Physical Therapist
- Elizabeth City, NC
National Provider Identifier
1306000864
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 7927
- Practice address
- 1075 US Highway 17 S
Elizabeth City, NC 27909-7628 - Phone
- (252) 338-3975
- NPI assigned
- Jul 14, 2008
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 7927 | NC | Primary |
| Physical Therapist | 225100000X | 20501 | CA |
Addresses
Primary practice location
1075 US Highway 17 S
Elizabeth City, NC 27909-7628
Mailing address
125 Long Pine Rd
South Mills, NC 27976-9611
Phone (252) 771-8305
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7927 | NC | MD | Professional Counselor |
| 20501 | CA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1215993600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1215993600000",
"number": "1306000864",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "125 LONG PINE RD",
"city": "SOUTH MILLS",
"state": "NC",
"postal_code": "279769611",
"telephone_number": "252-771-8305"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1075 US HIGHWAY 17 S",
"city": "ELIZABETH CITY",
"state": "NC",
"postal_code": "279097628",
"telephone_number": "252-338-3975"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "KITARSHYI",
"middle_name": "MULDROW",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-07-14",
"last_updated": "2008-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NC",
"license": "7927",
"primary": true
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "20501",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elizabeth City, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.