Kimberly S Jackson, MSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

ISW 3000 Issued in FL

Practice address

841 Jimmy Ann Dr
Daytona Beach, FL 32117-4583

Phone

(386) 425-3953

Fax

(386) 258-4912

NPI assigned

Dec 7, 2009

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Miss Kimberly S Harvey Former name

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": "1260144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363132800000",
    "number": "1801125638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "841 JIMMY ANN DR",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321174583",
            "telephone_number": "386-425-3953",
            "fax_number": "386-258-4912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "841 JIMMY ANN DR",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321174583",
            "telephone_number": "386-425-3953",
            "fax_number": "386-258-4912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KIMBERLY",
        "middle_name": "S",
        "name_prefix": "Mrs.",
        "credential": "MSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-12-07",
        "last_updated": "2013-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "FL",
            "license": "ISW 3000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "HARVEY",
            "middle_name": "S",
            "prefix": "MISS",
            "credential": "MSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Allen Thomas Jackson, MD
• Ashley Marie Jackson, LICSW, MSW
• Danielle Lawanna Jackson, RN
• Kayla Jackson
• Kimberly Jackson, OTR/L
• Monica R Jackson
• Raquel Jackson, PHARMD
• Jennifer Lee Jacobs, APRN
• David Neal Jacobsen, D.C.
• Ann Frances Jacobson, MD

• Social Worker in Daytona Beach, FL
• Providers in Daytona Beach, FL by specialty
• Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2013; 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.