Richard Chad Jackson

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

311 Issued in KY

Practice address

1 Trillium Way
Corbin, KY 40701-8426

Phone

(606) 523-8521

NPI assigned

Apr 24, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1467671982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 BARGO ST",
            "city": "LONDON",
            "state": "KY",
            "postal_code": "407412710",
            "telephone_number": "606-878-7658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 TRILLIUM WAY",
            "city": "CORBIN",
            "state": "KY",
            "postal_code": "407018426",
            "telephone_number": "606-523-8521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "RICHARD",
        "middle_name": "CHAD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KY",
            "license": "311",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CUMBERLAND HEALTHCARE INC",
            "identifier": "C62048",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Candace Camille Jackson, BA
• Debra Jackson
• Kayla Ann Jackson, BS
• Meghan Jackson, PHARMD
• Paula Jackson, PT
• Eleza Jacobs
• Brooke Elizabeth James, BS
• Sean William James, D.O.
• Amy Nicole Janutolo, BA
• Risham Javaid, MD

• Clinical Social Worker in Corbin, KY
• Providers in Corbin, KY by specialty
• Clinical Social Worker in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.