Active NPI
Kimberly Jackson
- Occupational Therapy Assistant
- North Augusta, SC
National Provider Identifier
1700595956
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 5410
- Practice address
- 350 Austin Graybill Rd
North Augusta, SC 29860-9251 - Phone
- (803) 278-4272
- NPI assigned
- Nov 16, 2022
- 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 |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 5410 | GA | Primary |
Addresses
Primary practice location
350 Austin Graybill Rd
North Augusta, SC 29860-9251
Mailing address
350 Austin Graybill Rd
North Augusta, SC 29860-9251
Phone (803) 278-4272
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 |
|---|---|---|---|
| 5410 | GA | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1668556800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1668556800000",
"number": "1700595956",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "350 AUSTIN GRAYBILL RD",
"city": "NORTH AUGUSTA",
"state": "SC",
"postal_code": "298609251",
"telephone_number": "803-278-4272",
"fax_number": "803-278-1794"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "350 AUSTIN GRAYBILL RD",
"city": "NORTH AUGUSTA",
"state": "SC",
"postal_code": "298609251",
"telephone_number": "803-278-4272"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "KIMBERLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-11-16",
"last_updated": "2022-11-16",
"certification_date": "2022-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "GA",
"license": "5410",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Augusta, SC
- Kandis Hutton
- Min Jung Hwang
- Illumination Psychiatry LLC
- Isd Renal Inc (Northridge Dialysis)
- J. William Thurmond III, MD LLC
- Josef Beethoven Jacobson, D.P.T.
- Victoria James, RN
- Jeffrey N Broder MD (North Augusta Urgent Care Family & Occupational Medicine Center)
- Jeffrey N Broder MD PC (North Agusta Urgent Care Family & Occupational Medicine)
- Millicent Porter Jenkins, FNP-C
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.