Individual provider Active NPI

Karen Renee' Jackson-Williams, DOM, LAC

  • Acupuncturist
  • Gambrills, MD
National Provider Identifier
1609012400
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
AcupuncturistTaxonomy code 171100000X
License
U01654 Issued in MD
Practice address
2401 Brandermill Blvd Ste 301
Gambrills, MD 21054-1604
Phone
(410) 774-0800
Fax
(410) 774-0799
NPI assigned
Dec 29, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acupuncturist 171100000X U01654 MD Primary

Addresses

Primary practice location

2401 Brandermill Blvd Ste 301
Gambrills, MD 21054-1604

Mailing address

2401 Brandermill Blvd Ste 301
Gambrills, MD 21054-1604
Phone (410) 774-0800

Other practice location 1

10028 DuBarry St
Glenn Dale, MD 20769-9248
Phone (410) 262-2488

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

LicenseStateTypeSpecialty
U01654MDMDAcupuncturist

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Integrative Health Group Acupuncturist PastSince Jul 24, 2022 Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1230508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1609012400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 BRANDERMILL BLVD STE 301",
            "city": "GAMBRILLS",
            "state": "MD",
            "postal_code": "210541604",
            "telephone_number": "410-774-0800",
            "fax_number": "410-774-0799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 BRANDERMILL BLVD STE 301",
            "city": "GAMBRILLS",
            "state": "MD",
            "postal_code": "210541604",
            "telephone_number": "410-774-0800",
            "fax_number": "410-774-0799"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10028 DuBarry St",
            "address_purpose": "LOCATION",
            "city": "Glenn Dale",
            "state": "MD",
            "postal_code": "207699248",
            "country_code": "US",
            "telephone_number": "410-262-2488",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON-WILLIAMS",
        "first_name": "KAREN",
        "middle_name": "RENEE'",
        "name_prefix": "Dr.",
        "credential": "DOM, LAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-12-29",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "MD",
            "license": "U01654",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gambrills, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.