Active NPI
Christian Jackson, BACHELOR
- Counselor
- Johnston, RI
National Provider Identifier
1427460484
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- Practice address
- 1443 Hartford Ave
Johnston, RI 02919-3224 - Phone
- (401) 724-8400
- Fax
- (401) 722-5280
- NPI assigned
- May 27, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | Primary |
Addresses
Primary practice location
1443 Hartford Ave
Johnston, RI 02919-3224
Mailing address
1443 Hartford Ave
Johnston, RI 02919-3224
Phone (401) 724-8400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GH57134 | Medicaid | RI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1401148800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1401148800000",
"number": "1427460484",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1443 HARTFORD AVE",
"city": "JOHNSTON",
"state": "RI",
"postal_code": "029193224",
"telephone_number": "401-724-8400",
"fax_number": "401-722-5280"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1443 HARTFORD AVE",
"city": "JOHNSTON",
"state": "RI",
"postal_code": "029193224",
"telephone_number": "401-724-8400",
"fax_number": "401-722-5280"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "CHRISTIAN",
"credential": "BACHELOR",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-05-27",
"last_updated": "2014-05-27",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "GH57134",
"state": "RI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Johnston, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.