Active NPI
Nicole L. Jackson, PH.D.
- Clinical Psychologist
- Columbus, OH
National Provider Identifier
1851641807
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 020203
- Practice address
- 420 North James Road
Columbus, OH 43219 - Phone
- (614) 257-5339
- NPI assigned
- Sep 18, 2012
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 020203 | NY | Primary |
| Psychologist | 103T00000X | 020203 | NY |
Addresses
Primary practice location
420 North James Road
Columbus, OH 43219
Mailing address
420 North James Road
Columbus, OH 43219
Phone (614) 257-5339
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 Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 020203 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1347926400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1456358400000",
"number": "1851641807",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "420 NORTH JAMES ROAD",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "43219",
"telephone_number": "614-257-5339"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "420 NORTH JAMES ROAD",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "43219",
"telephone_number": "614-257-5339"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "NICOLE",
"middle_name": "L.",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-09-18",
"last_updated": "2016-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "020203",
"primary": true
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NY",
"license": "020203",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbus, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.