Active NPI
Lacey Kristine Jackson
- Behavior Analyst
- Tyler, TX
National Provider Identifier
1639794746
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 3591
- Practice address
- 1537 E Grande Blvd
Tyler, TX 75703-3900 - Phone
- (903) 630-7077
- NPI assigned
- Jun 15, 2020
- 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 |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 3591 | TX | Primary |
Addresses
Primary practice location
1537 E Grande Blvd
Tyler, TX 75703-3900
Mailing address
1537 E Grande Blvd
Tyler, TX 75703-3900
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 |
|---|---|---|---|
| 3591 | TX | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1592179200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1759881600000",
"number": "1639794746",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1537 E GRANDE BLVD",
"city": "TYLER",
"state": "TX",
"postal_code": "757033900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1537 E GRANDE BLVD",
"city": "TYLER",
"state": "TX",
"postal_code": "757033900",
"telephone_number": "903-630-7077"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "LACEY",
"middle_name": "KRISTINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-06-15",
"last_updated": "2025-10-08",
"certification_date": "2025-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "TX",
"license": "3591",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.