Active NPI
Elisabeth Vennecia Jackson, M.D.
- Developmental - Behavioral Pediatrics Physician
- Dallas, TX
National Provider Identifier
1821416520
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmental - Behavioral Pediatrics Physician
- License
- J7527
- Practice address
- 2222 Welborn St
Texas Scottish Rite Hospital for Children
Dallas, TX 75219-3924 - Phone
- (214) 559-7817
- NPI assigned
- Mar 31, 2014
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Developmental - Behavioral Pediatrics Physician | 2080P0006X | J7527 | TX | Primary |
Addresses
Primary practice location
2222 Welborn St
Texas Scottish Rite Hospital for Children
Dallas, TX 75219-3924
Mailing address
2222 Welborn St
Texas Scottish Rite Hospital for Children
Dallas, TX 75219-3924
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| J7527 | TX | MD | Developmental - Behavioral Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1396224000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1396224000000",
"number": "1821416520",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2222 WELBORN ST",
"address_2": "TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN",
"city": "DALLAS",
"state": "TX",
"postal_code": "752193924"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2222 WELBORN ST",
"address_2": "TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN",
"city": "DALLAS",
"state": "TX",
"postal_code": "752193924",
"telephone_number": "214-559-7817"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "ELISABETH",
"middle_name": "VENNECIA",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-03-31",
"last_updated": "2014-03-31",
"status": "A"
},
"taxonomies": [
{
"code": "2080P0006X",
"taxonomy_group": "",
"desc": "Pediatrics, Developmental - Behavioral Pediatrics",
"state": "TX",
"license": "J7527",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.