Kristi Jackson
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Mayking, KY
NPI 1427364058 · NPPES record last updated Nov 19, 2010
Key facts
- NPI
- 1427364058
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- 0990 (KY)
- Practice address
- 3367 Hwy 119 N
Mayking, KY 41837 - Phone
- (606) 633-4439
- NPI assigned
- Aug 20, 2010
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0990 | KY | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kentucky River Community Care, Inc | Addiction (Substance Use Disorder) | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 0990 | KY | Yes |
Addresses
Primary practice location
3367 Hwy 119 N
Mayking, KY 41837
Mailing address
115 Rockwood LN
Hazard, KY 41701-9415
Phone (606) 436-5761
Other providers in Mayking, KY
- Cheryl Gibson
- Angela Goff
- Graybeal Orthopedic LLC
- Nancy Hatton
- Susan Carol Houston
- Nikki Lee Layne
- Lisa Marcum
- Andrea Mullins
- Michael Sparks
- Robin Thomas
All providers in Mayking, KY · Addiction (Substance Use Disorder) Counselor in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 19, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.