Jackara Shadasha Dewalt

Key facts

NPI

1376264192

Entity type

Individual (NPI type 1)

Primary specialty

Case Manager/Care Coordinator 171M00000X

Practice address

1600 Platt Springs Rd Apt 34
West Columbia, SC 29169-5542

Phone

(803) 290-0522

NPI assigned

Sep 9, 2022

Sex

Female

Sole proprietor

No

Organizations & group practices 1

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.

• New Day, Inc. of Spartanburg Community/Behavioral Health Agency · Spartanburg, SC · NPI 1851613186
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Practice roles

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 9, 2022.

{
    "created_epoch": "1662681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662681600000",
    "number": "1376264192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 S CHURCH ST",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293065231",
            "telephone_number": "803-290-0522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 PLATT SPRINGS RD APT 34",
            "city": "WEST COLUMBIA",
            "state": "SC",
            "postal_code": "291695542",
            "telephone_number": "803-290-0522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEWALT",
        "first_name": "JACKARA",
        "middle_name": "SHADASHA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-09",
        "last_updated": "2022-09-09",
        "certification_date": "2022-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Columbia, SC

• Kessler Derrrick, PHARMD
• Robert L. Deters, MD
• Heather Detwiler, PTA
• Karen Ann Devereaux, COTA
• Kristin K Devito, PA
• Raymond E Diamond, DO
• Angela Diaz, RN
• Pauline Dibia, MD
• Dickerson Center for Children, Inc
• Angela Paulette Diemont, APRN

All providers in West Columbia, SC · Case Manager/Care Coordinator in South Carolina