Atwalaun Chantelle Jackson, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

0000048918 Issued in TN

Practice address

1734 Madison Ave
Memphis, TN 38104-6414

Phone

(901) 722-9420

NPI assigned

Jun 12, 2013

Sex

Female

Sole proprietor

No

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": "1370995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370995200000",
    "number": "1912345869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1734 MADISON AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381046414",
            "telephone_number": "901-722-9420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1734 MADISON AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381046414",
            "telephone_number": "901-722-9420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ATWALAUN",
        "middle_name": "CHANTELLE",
        "name_prefix": "Mrs.",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-12",
        "last_updated": "2013-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "TN",
            "license": "0000048918",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adrienne Maxine Jackson-Payne, D.D.S.
• Jackson-Randle Family Healthcare, P.L.C.
• Adrienne Jackson
• Anna Martin Jackson, MD
• Ashiqua J Jackson, APRN
• Barbara Kay Jackson, MD
• Bewindi Aquilla Jackson, LCSW
• Biddie Ruth Jackson, B.P.S.
• Casey Gordon Jackson, M.D.
• Charity Nicole Jackson, BACHELORS

• Licensed Practical Nurse in Memphis, TN
• Providers in Memphis, TN by specialty
• Licensed Practical Nurse in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2013; 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.