Autumn Lynn Jackson

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

474 W Vermont Ave Ste 104
Escondido, CA 92025-6584

Phone

(760) 432-9884

NPI assigned

Dec 28, 2021

Last updated

Jun 10, 2024By 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 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Healthright 360

  • Substance Abuse Rehabilitation Facility
  • Escondido, CA
  • NPI 1952761454
  NPD (past)

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

{
    "created_epoch": "1640649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717977600000",
    "number": "1376203695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9465 FARNHAM ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921231308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "474 W VERMONT AVE STE 104",
            "city": "ESCONDIDO",
            "state": "CA",
            "postal_code": "920256584",
            "telephone_number": "760-432-9884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "AUTUMN",
        "middle_name": "LYNN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-12-28",
        "last_updated": "2024-06-10",
        "certification_date": "2024-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maryam Isordia Bernes, DDS
• Ivita, LLC
• Ivy Dell Ranch
• Anushka Iyer
• Aisha Jabarkhiel
• Frederic Leslie Jackson, DO, MPH
• Kambria Kelley Jackson, LVN
• Teresa E Jackson
• Eleni Jacobs
• Harold Sidney Jacobs, M.D.

• Case Manager/Care Coordinator in Escondido, CA
• Providers in Escondido, CA by specialty
• Case Manager/Care Coordinator in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 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.