Active NPI
Nakisha Robertson Jackson, PT, DPT
- Physical Therapist
- Fort Worth, TX
National Provider Identifier
1538374087
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1172173
- Practice address
- 5801 Bryant Irvin Rd
Fort Worth, TX 76132-4209 - Phone
- (817) 433-0810
- NPI assigned
- May 10, 2007
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1172173 | TX | Primary |
Addresses
Primary practice location
5801 Bryant Irvin Rd
Fort Worth, TX 76132-4209
Mailing address
5824 Crestview Dr
Grand Prairie, TX 75052-8507
Phone (985) 513-0221
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 |
|---|---|---|---|
| 1172173 | TX | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178755200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1339632000000",
"number": "1538374087",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5824 CRESTVIEW DR",
"city": "GRAND PRAIRIE",
"state": "TX",
"postal_code": "750528507",
"telephone_number": "985-513-0221"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5801 BRYANT IRVIN RD",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761324209",
"telephone_number": "817-433-0810"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "NAKISHA",
"middle_name": "ROBERTSON",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-10",
"last_updated": "2012-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TX",
"license": "1172173",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.