Tammy Lynn Jackson, PH.D.

Primary specialty

Adult Development & Aging PsychologistTaxonomy code 103TA0700X

License

31418 Issued in TX

Practice address

1014 Sun Meadow CT
College Station, TX 77845-7291

Phone

(979) 217-1311

Fax

(855) 604-0969

NPI assigned

Nov 7, 2005

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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.

• Deer Oaks Geriatric Services P C

  dba Deer Oaks Consultation Services

  • Clinical Psychologist
  • San Antonio, TX
  • NPI 1134169287
  NPD (past)
• Senior Health Bremond LLC

  dba Bremond Nursing and Rehab

  • Skilled Nursing Facility
  • Bremond, TX
  • NPI 1144229378
  NPD (past)
• Deer Oaks Mental Health Associates PC

  • Clinical Psychologist
  • Las Cruces, NM
  • NPI 1134175763
  NPD (past)

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

{
    "created_epoch": "1131321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692921600000",
    "number": "1619958758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1014 SUN MEADOW CT",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778457291",
            "telephone_number": "979-217-1311",
            "fax_number": "855-604-0969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1014 SUN MEADOW CT",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778457291",
            "telephone_number": "979-217-1311",
            "fax_number": "855-604-0969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "TAMMY",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-11-07",
        "last_updated": "2023-08-25",
        "certification_date": "2023-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "TX",
            "license": "31418",
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TA0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Adult Development & Aging",
            "state": "TX",
            "license": "31418",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "158249604",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nazish Ismail, FNP
• Iyabode Ogunlade, MD PA
• Analisa Jackson
• Holly Jackson, PA-C
• Rachel Lynn Jackson
• Jacob a Rendon, D.D.S., P.C. (Matthews Dental Group)
• Daniel Jacobi, MA, ATC, LAT
• Katie Lynn Jagge
• James Bonds MD
• James N Childs, M.D., P.a.

• Adult Development & Aging Psychologist in College Station, TX
• Providers in College Station, TX by specialty
• Adult Development & Aging Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.