Jerome Alexander-Terrell Jackson

Primary specialty

Foster Care AgencyTaxonomy code 253J00000X

License

10195508 Issued in AZ

Practice address

9680 W Northern Ave Unit 2311
Peoria, AZ 85345-4655

Phone

(989) 980-8286

Fax

(602) 455-4626

NPI assigned

Mar 3, 2020

Last updated

Mar 3, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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": "1583193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583193600000",
    "number": "1740815497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9680 W NORTHERN AVE UNIT 2311",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853454655",
            "telephone_number": "989-980-8286",
            "fax_number": "602-455-4626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9680 W NORTHERN AVE UNIT 2311",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853454655",
            "telephone_number": "989-980-8286",
            "fax_number": "602-455-4626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JEROME",
        "middle_name": "ALEXANDER-TERRELL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-03-03",
        "last_updated": "2020-03-03",
        "certification_date": "2020-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "385HR2055X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Mental Illness, Child",
            "state": "AZ",
            "license": "10195508",
            "primary": false
        },
        {
            "code": "253J00000X",
            "taxonomy_group": "",
            "desc": "Foster Care Agency",
            "state": "AZ",
            "license": "10195508",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Kaisa T Jacobsen, NP

• Foster Care Agency in Peoria, AZ
• Providers in Peoria, AZ by specialty
• Foster Care Agency in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2020; 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.