Nikkitta Antoinette Jackson

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

4703117130 Issued in MI

Practice address

20245 W 12 Mile Rd Ste 145
Southfield, MI 48076-6403

Phone

(734) 299-0208

NPI assigned

Sep 7, 2016

Last updated

Dec 22, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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": "1473206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1766361600000",
    "number": "1649727637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20245 W 12 MILE RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480765409",
            "telephone_number": "734-299-0208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20245 W 12 MILE RD STE 145",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480766403",
            "telephone_number": "734-299-0208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "NIKKITTA",
        "middle_name": "ANTOINETTE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-09-07",
        "last_updated": "2025-12-22",
        "certification_date": "2025-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "MI",
            "license": "4703117130",
            "primary": true
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "MI",
            "license": "7501017098",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jholene Jackson
• Kristin Jackson
• Kyla Jackson
• Laschay Jackson
• Meghan E Jackson, DPT
• Qiana Jackson
• Rayshonda Jackson
• Tamika Jackson
• Jacob Rayis, PLLC (The Counselor Therapy)
• David Jacobs, MD

• Licensed Practical Nurse in Southfield, MI
• Providers in Southfield, MI by specialty
• Licensed Practical Nurse in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 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.

Verify at the official NPI Registry.