Tammy Renee Jackson

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

Practice address

8991 W Flamingo Rd Ste 105
Las Vegas, NV 89147-0439

Phone

(702) 586-5001

Fax

(702) 664-0508

NPI assigned

Apr 3, 2021

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Impact Wellness Center,Inc

  • Community/Behavioral Health Agency
  • Las Vegas, NV
  • NPI 1902319411
  NPD (past)

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

{
    "created_epoch": "1617408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617408000000",
    "number": "1558940064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8991 W FLAMINGO RD STE 105",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891470439",
            "telephone_number": "702-586-5001",
            "fax_number": "702-664-0508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8991 W FLAMINGO RD STE 105",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891470439",
            "telephone_number": "702-586-5001",
            "fax_number": "702-664-0508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "TAMMY",
        "middle_name": "RENEE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-03",
        "last_updated": "2021-04-03",
        "certification_date": "2021-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "info@impact2day.org",
            "affiliation": "N",
            "address_1": "8991 W Flamingo Rd Ste 105",
            "city": "Las Vegas",
            "state": "NV",
            "country_code": "US",
            "postal_code": "891470439",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Stephanie Jackson
• Steven Jackson
• Summer Jackson
• Susan Nicole Jackson, CADC-1
• Ta'Sharie Jackson
• Tanesha Maraie Jackson
• Tanesia Jackson
• Taniya Jackson
• Tatiana Jackson
• Taveus Jackson

• Community Health Worker in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Community Health Worker in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2021; 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.