Active NPI
Patrick Dior Jackson
- School Counselor
- Louisville, KY
National Provider Identifier
1871141457
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Counselor
- License
- 201114318
- Practice address
- 5111 S 3Rd St
Louisville, KY 40214-2601 - Phone
- (502) 690-1511
- NPI assigned
- Aug 28, 2019
- Sex
- Male
- 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 |
|---|---|---|---|---|
| School Counselor | 101YS0200X | 201114318 | KY | Primary |
Addresses
Primary practice location
5111 S 3Rd St
Louisville, KY 40214-2601
Mailing address
811 Stonebench Cir
Jeffersonvlle, IN 47130-4220
Phone (812) 557-5365
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 |
|---|---|---|---|
| 201114318 | KY | MD | School Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1566950400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1566950400000",
"number": "1871141457",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "811 STONEBENCH CIR",
"city": "JEFFERSONVLLE",
"state": "IN",
"postal_code": "471304220",
"telephone_number": "812-557-5365"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5111 S 3RD ST",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402142601",
"telephone_number": "502-690-1511"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "PATRICK",
"middle_name": "DIOR",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-08-28",
"last_updated": "2019-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "101YS0200X",
"taxonomy_group": "",
"desc": "Counselor, School",
"state": "KY",
"license": "201114318",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Louisville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.