Billy Jerome Jackson

Primary specialty

DriverTaxonomy code 172A00000X

License

RQ788849 Issued in OH

Practice address

3225 Amanda Dr
Dayton, OH 45406-1102

Phone

(937) 789-6646

NPI assigned

Jan 5, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

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": "1609804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609804800000",
    "number": "1487242400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3225 AMANDA DR",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454061102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3225 AMANDA DR",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454061102",
            "telephone_number": "937-789-6646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "BILLY",
        "middle_name": "JEROME",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-01-05",
        "last_updated": "2021-01-05",
        "certification_date": "2021-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3747P1801X",
            "taxonomy_group": "",
            "desc": "Technician, Personal Care Attendant",
            "state": "OH",
            "license": null,
            "primary": false
        },
        {
            "code": "376J00000X",
            "taxonomy_group": "",
            "desc": "Homemaker",
            "state": "OH",
            "license": null,
            "primary": false
        },
        {
            "code": "172A00000X",
            "taxonomy_group": "",
            "desc": "Driver",
            "state": "OH",
            "license": "RQ788849",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexa Jackson
• Alexandria Jackson, RDN, LD
• Amanda Jackson
• Atiba Diarra Jackson, M.D.
• Bertha E Jackson
• Brenda Lynn Jackson, B.S. BUSINESS
• Carl'Averis Jackson
• Carroll S Jackson, L.I.S.W.
• Chinah Lynn Jackson
• Courtney Faith Jackson

• Driver in Dayton, OH
• Providers in Dayton, OH by specialty
• Driver in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2021; 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.