Active NPI
Kristi L Jackley, SPEECH PATHOLOGIST
- Speech-Language Pathologist
- Apopka, FL
National Provider Identifier
1649431412
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SA7750
- Practice address
- 525 Mount Argyll CT
Apopka, FL 32712-4738 - Phone
- (321) 230-1124
- Fax
- (321) 256-5211
- NPI assigned
- Jun 24, 2008
- Last updated
- Mar 5, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SL008163 | PA | |
| Speech-Language Pathologist | 235Z00000X | SA7750 | FL | Primary |
Addresses
Primary practice location
525 Mount Argyll CT
Apopka, FL 32712-4738
Mailing address
525 Mount Argyll CT
Apopka, FL 32712-4738
Phone (321) 230-1124
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003686500 | Medicaid | FL |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SL008163 | PA | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lkjackley LLC | Speech-Language Pathologist | Current | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1214265600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1583366400000",
"number": "1649431412",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "525 MOUNT ARGYLL CT",
"city": "APOPKA",
"state": "FL",
"postal_code": "327124738",
"telephone_number": "321-230-1124",
"fax_number": "321-256-5211"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "525 MOUNT ARGYLL CT",
"city": "APOPKA",
"state": "FL",
"postal_code": "327124738",
"telephone_number": "321-230-1124",
"fax_number": "321-256-5211"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKLEY",
"first_name": "KRISTI",
"middle_name": "L",
"credential": "SPEECH PATHOLOGIST",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-06-24",
"last_updated": "2020-03-05",
"certification_date": "2020-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "PA",
"license": "SL008163",
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "FL",
"license": "SA7750",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "003686500",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Apopka, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.