Individual provider Active NPI

Tameka Jackson, PH.D.

  • Psychologist
  • Sacramento, CA
National Provider Identifier
1568757771
Registry record updated Oct 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Practice address
1531 Corporate Way
Sacramento, CA 95831-3888
Phone
(916) 304-4602
NPI assigned
Jun 15, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X Primary

Addresses

Primary practice location

1531 Corporate Way
Sacramento, CA 95831-3888

Mailing address

9676 Sea Cliff CT
Elk Grove, CA 95758-7132
Phone (908) 208-4484

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141029002001 CA Practitioner - Clinical Psychologist 6709007032 Practice locations: Sacramento, CA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1531 Corporate Way
Sacramento, CA 95831-3888
Phone (916) 304-4602

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

NPI Registry JSON

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

{
    "created_epoch": "1308096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728432000000",
    "number": "1568757771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9676 SEA CLIFF CT",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957587132",
            "telephone_number": "908-208-4484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1531 CORPORATE WAY",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958313888",
            "telephone_number": "916-304-4602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "TAMEKA",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-15",
        "last_updated": "2024-10-09",
        "certification_date": "2024-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.