Tia Kyles Jackson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6588 Issued in TN

Practice address

1444 E Shelby Dr Ste 424
Memphis, TN 38116-7260

Phone

(901) 270-8522

NPI assigned

Aug 21, 2012

Last updated

Oct 18, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• Ms. Tia Kyles Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1345507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539820800000",
    "number": "1538417639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "747 CRESCENT AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381166209",
            "telephone_number": "901-270-8522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1444 E SHELBY DR STE 424",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381167260",
            "telephone_number": "901-270-8522"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "703 Calvin Avery Dr",
            "address_purpose": "LOCATION",
            "city": "West Memphis",
            "state": "AR",
            "postal_code": "723016501",
            "country_code": "US",
            "telephone_number": "870-732-1878",
            "fax_number": "870-702-7111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KYLES JACKSON",
        "first_name": "TIA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-21",
        "last_updated": "2018-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "AR",
            "license": "1861M",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AR",
            "license": "4461-C",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MS",
            "license": "C9077",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TN",
            "license": "6588",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "169031795",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TIA",
            "last_name": "KYLES",
            "prefix": "MS.",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• William Hanna Kutteh, M.D., PH.D
• Caitlin Renee Kutz, MD
• KV Quality Care
• Hakyong Gloria Kwak, MD
• Marie Kyle
• Monique Kyles, DNP, APRN, CPNP-PC
• Tracye Denise Kyles, M.D.
• Kyndal Home Health Care Inc
• Kyndal Home Health Care Inc
• L & M Transportation Services, Inc.

• Clinical Social Worker in Memphis, TN
• Providers in Memphis, TN by specialty
• Clinical Social Worker in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.