Active NPI
Kirsten Jackson, LCSW
- Clinical Social Worker
- Fort Worth, TX
National Provider Identifier
1780282228
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 60942
- Practice address
- 3000 S Hulen St Ste 124-649
Fort Worth, TX 76109-1929 - Phone
- (817) 383-5287
- NPI assigned
- Oct 16, 2020
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 60942 | TX | Primary |
Addresses
Primary practice location
3000 S Hulen St Ste 124-649
Fort Worth, TX 76109-1929
Mailing address
3000 S Hulen St Ste 124-649
Fort Worth, TX 76109-1929
Phone (817) 383-5287
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60942 | TX | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1602806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1644364800000",
"number": "1780282228",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3000 S HULEN ST STE 124-649",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761091929",
"telephone_number": "817-383-5287"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3000 S HULEN ST STE 124-649",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761091929",
"telephone_number": "817-383-5287"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "KIRSTEN",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-10-16",
"last_updated": "2022-02-09",
"certification_date": "2022-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Social Worker, Clinical",
"state": "TX",
"license": "60942",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.