Active NPI
Jeremiah Lee Jackson
- Physical Therapy Assistant
- La Follette, TN
National Provider Identifier
1538090121
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 8401
- Practice address
- 159 Noah LN
La Follette, TN 37766-5575 - Phone
- (865) 314-0005
- NPI assigned
- May 25, 2026
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 8401 | TN | Primary |
Addresses
Primary practice location
159 Noah LN
La Follette, TN 37766-5575
Mailing address
159 Noah LN
La Follette, TN 37766-5575
Phone (865) 314-0005
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8401 | TN | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1779667200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1784505600000",
"number": "1538090121",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "159 NOAH LN",
"city": "LA FOLLETTE",
"state": "TN",
"postal_code": "377665575",
"telephone_number": "865-314-0005",
"fax_number": "865-332-1900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "159 NOAH LN",
"city": "LA FOLLETTE",
"state": "TN",
"postal_code": "377665575",
"telephone_number": "865-314-0005"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "JEREMIAH",
"middle_name": "LEE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2026-05-25",
"last_updated": "2026-07-20",
"certification_date": "2026-07-20",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "TN",
"license": "8401",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Follette, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.