Heather Kaye Jackson

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

License

F23-104260 Issued in UT

Practice address

1200 Towne Centre Blvd SPC 1142
Provo, UT 84601-2941

Phone

(972) 658-4509

NPI assigned

Aug 29, 2023

Last updated

Aug 29, 2023By 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 1

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": "1693267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693267200000",
    "number": "1720863764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "312 MEADOWLARK DR",
            "city": "ALPINE",
            "state": "UT",
            "postal_code": "840041371",
            "telephone_number": "972-658-4509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 TOWNE CENTRE BLVD SPC 1142",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846012941",
            "telephone_number": "972-658-4509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "HEATHER",
        "middle_name": "KAYE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-08-29",
        "last_updated": "2023-08-29",
        "certification_date": "2023-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "UT",
            "license": "F23-104260",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexis Jackson
• Brooke Jackson
• Brooklynn Jackson
• Emilee Jackson
• Haley W Jackson, MD
• Jeffrey Brown Jackson, PH.D., LMFT
• John W Jackson, M.D.
• Mark Aaron Jackson
• Megan Jackson
• Richard T Jackson, MD

• Developmentally Disabled Services Day Training Agency in Provo, UT
• Providers in Provo, UT by specialty
• Developmentally Disabled Services Day Training Agency in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2023; 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.