Robin Jackson

Primary specialty

Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0808X

License

041413313 Issued in IL

Practice address

21121 Christina Dr
Matteson, IL 60443-3003

Phone

(312) 218-7409

NPI assigned

Jun 12, 2019

Sex

Female

Sole proprietor

No

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": "1560297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560297600000",
    "number": "1720647670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21121 CHRISTINA DR",
            "city": "MATTESON",
            "state": "IL",
            "postal_code": "604433003",
            "telephone_number": "312-218-7409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21121 CHRISTINA DR",
            "city": "MATTESON",
            "state": "IL",
            "postal_code": "604433003",
            "telephone_number": "312-218-7409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ROBIN",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-12",
        "last_updated": "2019-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "IN",
            "license": "28208253A",
            "primary": false
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "IL",
            "license": "041413313",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Couren Jackson
• Derrick Jackson
• Jordyne Jackson
• Kayla Jackson
• Reginald P Jackson
• Robyn A Jackson, M.D.
• Jasmine Perkins & Company LLC
• Tamela S Jasper
• Christopher Jeffers
• Treacie Gill Jelks

• Psychiatric/Mental Health Registered Nurse in Matteson, IL
• Providers in Matteson, IL by specialty
• Psychiatric/Mental Health Registered Nurse in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2019; 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.