Tana Jackson-Wilson

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

LP048815 Issued in AZ

Practice address

4612 N 28TH St
Camelback HS Medically Fragile
Phoenix, AZ 85016-4931

Phone

(602) 764-7122

NPI assigned

Sep 4, 2013

Sex

Female

Sole proprietor

No

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1378252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378252800000",
    "number": "1639504152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4612 N 28TH ST",
            "address_2": "CAMELBACK HS MEDICALLY FRAGILE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850164931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4612 N 28TH ST",
            "address_2": "CAMELBACK HS MEDICALLY FRAGILE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850164931",
            "telephone_number": "602-764-7122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON-WILSON",
        "first_name": "TANA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-04",
        "last_updated": "2013-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "AZ",
            "license": "LP048815",
            "primary": true
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "IL",
            "license": "043114639",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jackrabbit Family Medicine Inc
• Jackson Emprise L.L.C.
• Lindsey Jackson Lane
• Paige Jackson Smith, MD
• Megan Jackson-Hamus
• Anthony Rashad Jackson, PA
• Azel Jackson, LPC
• Beverly Yvonne Jackson, RN, MSN
• Brock Jackson, MD
• Byron Jackson

• Licensed Practical Nurse in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Licensed Practical Nurse in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2013; 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.