Christian Nicole Record-Jackson, PSY 0810008030

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

0810008030 Issued in VA

Practice address

1100 Wilford Hall Loop
Jbsa Lackland, TX 78236-5638

Phone

(210) 292-6255

Fax

(210) 292-7934

NPI assigned

Apr 24, 2018

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

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1524528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779062400000",
    "number": "1407344518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3905 26TH ST",
            "city": "CHESAPEAKE BEACH",
            "state": "MD",
            "postal_code": "207329383",
            "telephone_number": "831-239-8364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 WILFORD HALL LOOP",
            "city": "JBSA LACKLAND",
            "state": "TX",
            "postal_code": "782365638",
            "telephone_number": "210-292-6255",
            "fax_number": "210-292-7934"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1060 W Perimeter Rd",
            "address_purpose": "LOCATION",
            "city": "Jb Andrews",
            "state": "MD",
            "postal_code": "207626602",
            "country_code": "US",
            "telephone_number": "240-857-7186",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RECORD-JACKSON",
        "first_name": "CHRISTIAN",
        "middle_name": "NICOLE",
        "credential": "PSY 0810008030",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-24",
        "last_updated": "2026-05-18",
        "certification_date": "2026-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CA",
            "license": "105956",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810008030",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Veling Radtke, MD
• Kevin Duane Rasmussen, DDS
• Kelly Anne Rayburn, PA-C
• Laura Elizabeth Reardon, PHD
• Kristina Reck, DMD
• Donovan Stephen Reed, MD
• Lateasa Reed, LCSW
• Maverick Hunter Reed, PHARMD
• Nadia S Regis, NP
• Candice Marie Reiter, DDS

• Clinical Psychologist in Jbsa Lackland, TX
• Providers in Jbsa Lackland, TX by specialty
• Clinical Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.