Active NPI
Tawanna Jackson
- Health Educator
- Dallas, TX
National Provider Identifier
1619121365
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Health Educator
- License
- 110587
- Practice address
- 3824 Cedar Springs Rd
Dallas, TX 75219-4136 - Phone
- (214) 555-1111
- NPI assigned
- Nov 7, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Educator | 174H00000X | 110587 | TX | Primary |
Addresses
Primary practice location
3824 Cedar Springs Rd
Dallas, TX 75219-4136
Mailing address
3824 Cedar Springs Rd
Dallas, TX 75219-4136
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
| License | State | Type | Specialty |
|---|---|---|---|
| 110587 | TX | MD | Health Educator |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1226016000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1415836800000",
"number": "1619121365",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3824 CEDAR SPRINGS RD",
"city": "DALLAS",
"state": "TX",
"postal_code": "752194136"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3824 CEDAR SPRINGS RD",
"city": "DALLAS",
"state": "TX",
"postal_code": "752194136",
"telephone_number": "214-555-1111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "TAWANNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-11-07",
"last_updated": "2014-11-13",
"status": "A"
},
"taxonomies": [
{
"code": "174H00000X",
"taxonomy_group": "",
"desc": "Health Educator",
"state": "TX",
"license": "110587",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.