Active NPI
Xakirah Jackson
- Behavior Technician
- Flint, MI
National Provider Identifier
1538577804
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- J250920071040
- Practice address
- 420 W 5TH Ave
Flint, MI 48503-2445 - Phone
- (810) 257-3736
- NPI assigned
- Jul 30, 2014
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | J250920071040 | MI | |
| Behavior Technician | 106S00000X | J250920071040 | MI | Primary |
Addresses
Primary practice location
420 W 5TH Ave
Flint, MI 48503-2445
Mailing address
420 W 5TH Ave
Flint, MI 48503-2445
Phone (810) 257-3736
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 |
|---|---|---|---|
| J250920071040 | MI | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1406678400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687305600000",
"number": "1538577804",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "420 W 5TH AVE",
"city": "FLINT",
"state": "MI",
"postal_code": "485032445",
"telephone_number": "810-257-3736"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "420 W 5TH AVE",
"city": "FLINT",
"state": "MI",
"postal_code": "485032445",
"telephone_number": "810-257-3736"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "XAKIRAH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-07-30",
"last_updated": "2023-06-21",
"certification_date": "2023-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "MI",
"license": "J250920071040",
"primary": false
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "MI",
"license": "J250920071040",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Flint, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.