Active NPI
Clissie Terersa Jackson, HOME CARE
- Nurse's Aide
- Birmingham, AL
National Provider Identifier
1467721829
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(1) exclusion effective Jun 19, 2025.
Key facts
NPPES NPI Registry- Primary specialty
- Nurse's Aide
- License
- 119405B
- Practice address
- 208 74TH St N
Birmingham, AL 35206-4261 - Phone
- (313) 358-0035
- Fax
- (186) 665-9907
- NPI assigned
- Dec 14, 2011
- Last updated
- Dec 14, 2011
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Nurse's Aide | 376K00000X | 119405B | MO | Primary |
Addresses
Primary practice location
208 74TH St N
Birmingham, AL 35206-4261
Mailing address
208 74TH St N
Birmingham, AL 35206-4261
Phone (313) 358-0035
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
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 119405B | MO | MD | Nurse's Aide |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1323820800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323820800000",
"number": "1467721829",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "208 74TH ST N",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352064261",
"telephone_number": "313-358-0035",
"fax_number": "186-665-9907"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "208 74TH ST N",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352064261",
"telephone_number": "313-358-0035",
"fax_number": "186-665-9907"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "CLISSIE",
"middle_name": "TERERSA",
"credential": "HOME CARE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-12-14",
"last_updated": "2011-12-14",
"status": "A"
},
"taxonomies": [
{
"code": "376K00000X",
"taxonomy_group": "",
"desc": "Nurse's Aide",
"state": "MO",
"license": "119405B",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Birmingham, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.