Marcie Jackson

Primary specialty

Adult Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0809X

License

4704297558 Issued in MI

Practice address

43825 Michigan Ave
Canton, MI 48188-2551

Phone

(734) 397-3088

NPI assigned

Sep 23, 2021

Sex

Female

Sole proprietor

Yes

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

State licenses

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

{
    "created_epoch": "1632355200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632355200000",
    "number": "1871264309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15115 ARTESIAN ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482232282",
            "telephone_number": "313-828-1131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43825 MICHIGAN AVE",
            "city": "CANTON",
            "state": "MI",
            "postal_code": "481882551",
            "telephone_number": "734-397-3088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MARCIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-09-23",
        "last_updated": "2021-09-23",
        "certification_date": "2021-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0809X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Adult",
            "state": "MI",
            "license": "4704297558",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christine A Jack, OD
• Chermika Jackson
• Dejuana Cherise Jackson, NP
• Kyla Jackson
• Madeline Patricia Jackson, CNIM
• Roshani Jadia, M.D.
• Shashwat Jalukar, PT
• Mohamed Jamal, FNP-BC
• Saadiq Jamaluddin
• Rashonda Jamerson

• Adult Psychiatric/Mental Health Registered Nurse in Canton, MI
• Providers in Canton, MI by specialty
• Adult Psychiatric/Mental Health Registered Nurse in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2021; 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.