Active NPI
Kiesha L Jackson
- Health & Wellness Coach
- Plano, TX
National Provider Identifier
1891665170
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Health & Wellness Coach
- License
- NA
- Practice address
- 101 E Park Blvd Ste 600
Plano, TX 75074-8818 - Phone
- (469) 864-0497
- NPI assigned
- Nov 11, 2025
- Sex
- Unspecified or another gender identity
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | NA | TX | |
| Health Educator | 174H00000X | NA | MS | |
| Health & Wellness Coach | 171400000X | NA | TX | Primary |
Addresses
Primary practice location
101 E Park Blvd Ste 600
Plano, TX 75074-8818
Mailing address
101 E Park Blvd Ste 600
Plano, TX 75074-8818
Phone (469) 864-0497
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1762819200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1762819200000",
"number": "1891665170",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 E PARK BLVD STE 600",
"city": "PLANO",
"state": "TX",
"postal_code": "750748818",
"telephone_number": "469-864-0497"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 E PARK BLVD STE 600",
"city": "PLANO",
"state": "TX",
"postal_code": "750748818",
"telephone_number": "469-864-0497"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "KIESHA",
"middle_name": "L",
"sole_proprietor": "NO",
"sex": "X",
"enumeration_date": "2025-11-11",
"last_updated": "2025-11-11",
"certification_date": "2025-11-11",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "TX",
"license": "NA",
"primary": false
},
{
"code": "174H00000X",
"taxonomy_group": "",
"desc": "Health Educator",
"state": "MS",
"license": "NA",
"primary": false
},
{
"code": "171400000X",
"taxonomy_group": "",
"desc": "Health & Wellness Coach",
"state": "TX",
"license": "NA",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plano, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.