Shelby L Jackson, A.A.S / QMHS

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

4710 Old Troy Pike
Dayton, OH 45424-5740

Phone

(937) 233-1230

Fax

(937) 236-8930

NPI assigned

Apr 27, 2018

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Associate of Applied Science

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1524787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524787200000",
    "number": "1811485675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4710 OLD TROY PIKE",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454245740",
            "telephone_number": "937-233-1230",
            "fax_number": "937-236-8930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4710 OLD TROY PIKE",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454245740",
            "telephone_number": "937-233-1230",
            "fax_number": "937-236-8930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SHELBY",
        "middle_name": "L",
        "credential": "A.A.S / QMHS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-27",
        "last_updated": "2018-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Parita Jackson
• Robert Jackson
• Sakisha Vernee' Jackson, LPN
• Sarah Jackson
• Shatonne Dianne Jackson, LPN
• Shelia M Jackson
• Tabiah Samone Jackson
• Thia R Jackson
• Tiesha K Jackson
• Tiffany Jackson

• Case Manager/Care Coordinator in Dayton, OH
• Providers in Dayton, OH by specialty
• Case Manager/Care Coordinator in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2018; 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.