Jackie D Nickson, OTD, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OT1986 Issued in MS

Practice address

6664 Sinclair Dr
Horn Lake, MS 38637-2598

Phone

(901) 230-4982

Fax

(662) 393-2673

NPI assigned

Sep 20, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 6

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1379635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1389484800000",
    "number": "1356777411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6664 SINCLAIR DR",
            "city": "HORN LAKE",
            "state": "MS",
            "postal_code": "386372598",
            "telephone_number": "901-230-4982",
            "fax_number": "662-393-2673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6664 SINCLAIR DR",
            "city": "HORN LAKE",
            "state": "MS",
            "postal_code": "386372598",
            "telephone_number": "901-230-4982",
            "fax_number": "662-393-2673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKSON",
        "first_name": "JACKIE",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "OTD, OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-09-20",
        "last_updated": "2014-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MS",
            "license": "OT1986",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapist",
            "state": "MS",
            "license": "1986",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "MS",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "MS",
            "license": null,
            "primary": false
        },
        {
            "code": "224Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapy Assistant",
            "state": "MS",
            "license": null,
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapy Assistant",
            "state": "MS",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelsey Barnett Mize
• Yolanda Murry, FNP-C
• Newsom Healthcare of Desoto County, LLC
• Newsom Healthcare, Inc
• Sandra Newsom, FNP
• Shelley Marie Nordstrom Hammond, PHARMD
• Patrick O'Briant
• Lanissa Danielle Odor, FNP-BC
• Optimal Wellness 365 LLC
• Sheila Parr, MS

• Occupational Therapist in Horn Lake, MS
• Providers in Horn Lake, MS by specialty
• Occupational Therapist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.