Tyler Alana Jackson

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

License

J25080199625 Issued in IL

Practice address

121 E Historic Columbia River Hwy
Troutdale, OR 97060-2006

Phone

(971) 293-9237

NPI assigned

Jul 23, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Youth Unlimited Inc.

  • Foster Care Agency
  • Troutdale, OR
  • NPI 1992228498
  NPD

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

{
    "created_epoch": "1721692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721692800000",
    "number": "1538997366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 E HISTORIC COLUMBIA RIVER HWY",
            "city": "TROUTDALE",
            "state": "OR",
            "postal_code": "970602006",
            "telephone_number": "214-934-4344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 E HISTORIC COLUMBIA RIVER HWY",
            "city": "TROUTDALE",
            "state": "OR",
            "postal_code": "970602006",
            "telephone_number": "971-293-9237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "TYLER",
        "middle_name": "ALANA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-23",
        "last_updated": "2024-07-23",
        "certification_date": "2024-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "IL",
            "license": "J25080199625",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrew Holden
• Maria Hollister
• Alexandra Hunt
• Infinite Adult Care LLC
• Samantha Inzunza
• Jake Salaz DC PC
• Ryan Christian Jennings-Tidwell
• Estela Jimenez
• Christopher Edward Johnson
• Juwon Johnson

• All providers in Troutdale, OR
• Case Manager/Care Coordinator in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2024; 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.