Selena Jackson, MS

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2781 Issued in KS

Practice address

1901 E 1St St
Newton, KS 67114-5010

Phone

(316) 284-6400

NPI assigned

Jul 19, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jun 1, 2026 through Jun 1, 2028

Specialty

Clinical Psychologist

Education

Other, 2018

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science, Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Forsyth Medical Group LLC

  • Otolaryngology Physician
  • Monroe, NC
  • NPI 1710866405
  NPD
• Forsyth Medical Group, LLC

  • Obstetrics & Gynecology Physician
  • Hendersonville, NC
  • NPI 1750081378

  Clinical

  NPD

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

{
    "created_epoch": "1500422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1500422400000",
    "number": "1679096960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2931 N GOVERNEOUR ST APT 306",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672261783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 E 1ST ST",
            "city": "NEWTON",
            "state": "KS",
            "postal_code": "671145010",
            "telephone_number": "316-284-6400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SELENA",
        "credential": "MS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-19",
        "last_updated": "2017-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "KS",
            "license": "2781",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carolyn Ingersoll
• Shelly Ann Ingram, MS, LCMFT
• Integrity Medicine LLC
• Alayna Irwin
• Joshua Dean Jackson
• Michele I Janssens, SLP
• Jonathan W Jantz, MD, FAAP
• Michael Janzen, LMSW
• Zora Genevieve Jenney, MD
• Joanna L Runge R P T P a

• Clinical Psychologist in Newton, KS
• Providers in Newton, KS by specialty
• Clinical Psychologist in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.