Kelly Jackson

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW16096 Issued in FL

Practice address

111 SE 1St Ave
Ste 130
Gainesville, FL 32601-9913

Phone

(352) 246-5490

NPI assigned

Oct 21, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1445385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617753600000",
    "number": "1588036263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2937 NE 16TH TER",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326093234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 SE 1ST AVE",
            "address_2": "STE 130",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326019913",
            "telephone_number": "352-246-5490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KELLY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-10-21",
        "last_updated": "2021-04-07",
        "certification_date": "2021-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW16096",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "ISW 9557",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janale Jackson
• Jasmine Lashae Jackson
• Jeffrey Jackson, D.D.S
• Jennifer Jackson
• Julia Jackson, LCSW
• Latonia Jackson
• Laverne Isabell Jackson
• Linda Jackson
• Lisa Jackson, LMT, PT, AS, CHHC
• Mark A Jackson

• Clinical Social Worker in Gainesville, FL
• Providers in Gainesville, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 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.