Tierra Leanne Jackson, TATTOO LICENSE

Primary specialty

Rehabilitation PractitionerTaxonomy code 225400000X

License

2021043963 Issued in MO

Practice address

3322 S Campbell Ave # X
Springfield, MO 65807-4980

Phone

(417) 771-5540

NPI assigned

Nov 20, 2024

Last updated

Nov 20, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

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": "1732060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732060800000",
    "number": "1366267627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3322 S CAMPBELL AVE # X",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658074980",
            "telephone_number": "417-771-5540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3322 S CAMPBELL AVE # X",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658074980",
            "telephone_number": "417-771-5540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "TIERRA",
        "middle_name": "LEANNE",
        "credential": "TATTOO LICENSE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-11-20",
        "last_updated": "2024-11-20",
        "certification_date": "2024-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "247200000X",
            "taxonomy_group": "",
            "desc": "Technician, Other",
            "state": "MO",
            "license": "2021043963",
            "primary": false
        },
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": "MO",
            "license": "2021043963",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Delilah Yvette Jackson
• Michael Wayne Jackson, D.C.
• Rachael M Jackson, LMSW
• Sarah Beth Jackson, DDS
• Shawn Barrett Jackson, M,D,
• Wendy R Jackson, LCSW
• Jacob's Home Care LLC
• Blake Jacobs, MD
• Courtney M. Jacobson, LCSW
• Ryinne A Jacquemin, NASM-CPT

• Rehabilitation Practitioner in Springfield, MO
• Providers in Springfield, MO by specialty
• Rehabilitation Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2024; 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.