Kimberly Dawn Jackson, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

2009036113 Issued in MO

Practice address

10901 E Winner Rd
Independence, MO 64052-3755

Phone

(816) 254-3652

Fax

(816) 254-9243

NPI assigned

May 11, 2010

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

• Ms. Kimberly Dawn Jackson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: kimberly.jackson@direct.tmcmed.org

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

{
    "created_epoch": "1273536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1273536000000",
    "number": "1821316159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10901 E WINNER RD",
            "city": "INDEPENDENCE",
            "state": "MO",
            "postal_code": "640523755",
            "telephone_number": "816-254-3652",
            "fax_number": "816-254-9243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10901 E WINNER RD",
            "city": "INDEPENDENCE",
            "state": "MO",
            "postal_code": "640523755",
            "telephone_number": "816-254-3652",
            "fax_number": "816-254-9243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KIMBERLY",
        "middle_name": "DAWN",
        "name_prefix": "Ms.",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-05-11",
        "last_updated": "2010-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MO",
            "license": "2009036113",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "JACKSON",
            "middle_name": "DAWN",
            "prefix": "MS.",
            "credential": "LPC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Keila K Jackson-Anderson, MSW, LCSW
• Christian Jackson, CRNA
• Davin Jackson
• Haleigh D Jackson, DPT
• Jasmine Jackson
• Taylor Michele Jackson, LPC
• Mari Jacoby
• Andrea Leigh Jagels, LMSW
• James B. Doty, D.C., P.C. (Back & Neck Pain Center)
• Dayja' James, M.S.

• Professional Counselor in Independence, MO
• Providers in Independence, MO by specialty
• Professional Counselor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2010; 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.