Active NPI
Zachary Lynn Jackson
- Physical Therapist
- Kingsport, TN
National Provider Identifier
1881266559
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 12716
- Practice address
- 1661 Newbern Rd
Kingsport, TN 37664-3137 - Phone
- (423) 335-0535
- NPI assigned
- Jul 13, 2021
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 12716 | TN | Primary |
Addresses
Primary practice location
1661 Newbern Rd
Kingsport, TN 37664-3137
Mailing address
1661 Newbern Rd
Kingsport, TN 37664-3137
Phone (423) 335-0535
Other practice location 1
105 W Stone Dr
Kingsport, TN 37660-3365
Phone (423) 392-0469
Other practice location 2
915 Holston Hills Dr
Kingsport, TN 37664-4167
Phone (423) 246-1100
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | NA | Other |
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1626134400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1626220800000",
"number": "1881266559",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1661 NEWBERN RD",
"city": "KINGSPORT",
"state": "TN",
"postal_code": "376643137",
"telephone_number": "423-335-0535"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1661 NEWBERN RD",
"city": "KINGSPORT",
"state": "TN",
"postal_code": "376643137",
"telephone_number": "423-335-0535"
}
],
"practiceLocations": [
{
"address_1": "105 W Stone Dr",
"address_purpose": "LOCATION",
"city": "Kingsport",
"state": "TN",
"postal_code": "376603365",
"country_code": "US",
"telephone_number": "423-392-0469",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "915 Holston Hills Dr",
"address_purpose": "LOCATION",
"city": "Kingsport",
"state": "TN",
"postal_code": "376644167",
"country_code": "US",
"telephone_number": "423-246-1100",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JACKSON",
"first_name": "ZACHARY",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-07-13",
"last_updated": "2021-07-14",
"certification_date": "2021-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TN",
"license": "12716",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "NA",
"affiliation": "N",
"endpointDescription": "NA",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "NA",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "NA",
"address_1": "105 W Stone Dr",
"city": "Kingsport",
"state": "TN",
"country_code": "US",
"postal_code": "376603365",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Kingsport, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 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.