Antimoore H. Jackson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

1568-C Issued in AR

Practice address

14617 Sara Dr
Little Rock, AR 72206-5410

Phone

(501) 952-5275

Fax

(501) 888-3576

NPI assigned

May 8, 2007

Sex

Male

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

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/DICFDD/Endpoint/DICFDD

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.

• A 1 U.S. Compnay, Inc.

  • Clinical Social Worker
  • Little Rock, AR
  • NPI 1689887390
  NPD (past) Authorized official

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

{
    "created_epoch": "1178582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1376756098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14617 SARA DR",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722065410",
            "telephone_number": "501-952-5275",
            "fax_number": "501-888-3576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14617 SARA DR",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722065410",
            "telephone_number": "501-952-5275",
            "fax_number": "501-888-3576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ANTIMOORE",
        "middle_name": "H.",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-08",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AR",
            "license": "1568-C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Myoshi Bernadette Jackson-Austin, APN
• Lenora Jackson-Ayers, LMSW
• A. Gail Jackson, MS, SLP
• Alexis Jackson, CD-L, CD-PIC
• Alissa Honghiran Jackson, PT
• Ashlee Jackson, MHPP
• Brandon Jackson
• Caitlin Rachelle Jackson, APRN CPNP-PC
• Cayla-Marie Jackson, RD, LD
• Charissa Jackson

• Clinical Social Worker in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Clinical Social Worker in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.