Misty Marie Jackson, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

A5057 Issued in MD

Practice address

48 Tarn Ter
Frostburg, MD 21532-1242

Phone

(301) 689-1391

NPI assigned

Jan 12, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Misty Marie Anderson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1705017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705017600000",
    "number": "1457122012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "57 JACKSON ST",
            "city": "LONACONING",
            "state": "MD",
            "postal_code": "215391307",
            "telephone_number": "240-609-9594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "48 TARN TER",
            "city": "FROSTBURG",
            "state": "MD",
            "postal_code": "215321242",
            "telephone_number": "301-689-1391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MISTY",
        "middle_name": "MARIE",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-12",
        "last_updated": "2024-01-12",
        "certification_date": "2024-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MD",
            "license": "A5057",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MISTY",
            "last_name": "ANDERSON",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Peter Trytsman Hart, D.D.S.
• Westley Travis Hartley, P.A.-C
• Heather Hartman
• Caitlyn Heavner, OTR/L
• Katie Hovis, COTA/L
• Wendy Jacobs
• Jacqueline Palaisa DMD Ms
• Beth Ann Jeter
• Omowunmi Jolaoso, ATC, CSCS
• Hillary Nicole Jones, LAT, ATC

• Physical Therapy Assistant in Frostburg, MD
• Providers in Frostburg, MD by specialty
• Physical Therapy Assistant in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2024; 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.