Active NPI
Jasmine Tackett
- Social Worker
- Merrillville, IN
National Provider Identifier
1801612957
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 33012226A
- Practice address
- 2924 W 79TH PL
Merrillville, IN 46410-5211 - Phone
- (260) 704-1238
- NPI assigned
- Nov 22, 2024
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 150113687 | IL | |
| Social Worker | 104100000X | 33012226A | IN | Primary |
Addresses
Primary practice location
2924 W 79TH PL
Merrillville, IN 46410-5211
Mailing address
2924 W 79TH PL
Merrillville, IN 46410-5211
Phone (260) 704-1238
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 150113687 | IL | MD | Social Worker |
| 33012226A | IN | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1732233600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1732233600000",
"number": "1801612957",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2924 W 79TH PL",
"city": "MERRILLVILLE",
"state": "IN",
"postal_code": "464105211",
"telephone_number": "260-704-1238"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2924 W 79TH PL",
"city": "MERRILLVILLE",
"state": "IN",
"postal_code": "464105211",
"telephone_number": "260-704-1238"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TACKETT",
"first_name": "JASMINE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-11-22",
"last_updated": "2024-11-22",
"certification_date": "2024-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "IL",
"license": "150113687",
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "IN",
"license": "33012226A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Merrillville, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.