Individual provider Active NPI

Tamara Shayla Jaggers, LCSW

  • Clinical Social Worker
  • Cecilia, KY
National Provider Identifier
1699642140
Registry record updated Mar 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCSW00001177 Issued in KY
Practice address
931 E Main St
Cecilia, KY 42724-7614
Phone
(844) 435-0900
Fax
(270) 858-4029
NPI assigned
Oct 20, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LCSW00001177 KY Primary

Addresses

Primary practice location

931 E Main St
Cecilia, KY 42724-7614

Mailing address

PO Box 1080
Burkesville, KY 42717-1080
Phone (270) 858-6655

Other names 1

  • Tamara Shayla Duerson Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251205000500 KY Practitioner - Clinical Social Worker 6305339557 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2023
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

PO Box
Suite 1080
Burkesville, KY 42717

PO Box
Suite 1080
Burkesville, KY 42717-1080

PO Box
Suite 2399
Russell Springs, KY 42642

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LCSW00001177KYMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Cumberland Family Medical Center Inc Current Accepting new patients
Cumberland Family Medical Center Inc CurrentSince Dec 8, 2025 Accepting new patients
Cumberland Family Medical Center Inc CurrentSince Dec 8, 2025 Accepting new patients

Locations

360 Keen St
Burkesville, KY 42717
Phone (270) 864-1472

931 E Main St
Cecilia, KY 42724
Phone (270) 766-1397

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1760918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772496000000",
    "number": "1699642140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1080",
            "city": "BURKESVILLE",
            "state": "KY",
            "postal_code": "427171080",
            "telephone_number": "270-858-6655",
            "fax_number": "270-858-4027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "931 E MAIN ST",
            "city": "CECILIA",
            "state": "KY",
            "postal_code": "427247614",
            "telephone_number": "844-435-0900",
            "fax_number": "270-858-4029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAGGERS",
        "first_name": "TAMARA",
        "middle_name": "SHAYLA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-10-20",
        "last_updated": "2026-03-03",
        "certification_date": "2026-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KY",
            "license": "LCSW00001177",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TAMARA",
            "last_name": "DUERSON",
            "middle_name": "SHAYLA",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Cecilia, KY

Sources for this page

Verify at the official NPI Registry.