Amber Adney Jackson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

1934-C Issued in AR

Practice address

528 N College Ave Ste 2
Fayetteville, AR 72701-3401

Phone

(479) 856-9956

Fax

(888) 455-6401

NPI assigned

May 31, 2006

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

Other identifiers 2

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": "1149033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639526400000",
    "number": "1912944158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "528 N COLLEGE AVE STE 2",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727013401",
            "telephone_number": "479-856-9956",
            "fax_number": "888-455-6401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "528 N COLLEGE AVE STE 2",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727013401",
            "telephone_number": "479-856-9956",
            "fax_number": "888-455-6401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "AMBER",
        "middle_name": "ADNEY",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-05-31",
        "last_updated": "2021-12-15",
        "certification_date": "2021-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AR",
            "license": "1934-C",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PROVIDER #",
            "identifier": "5Y354",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BEACON HEALTH",
            "identifier": "747768",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marie N Isler
• Kristen Isles
• Jasmine Istre
• J Cole White DDS PA
• Tara J Jackson-Farmer
• Carol Jackson, LISW - S, LICDC
• Charles David Jackson, MD
• Charles Mark Jackson, M.D.
• Edward Leslie Jackson, M.D.
• Holly Jackson, DPT

• Clinical Social Worker in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Clinical Social Worker in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 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.