Denise Jackson

Primary specialty

Personal Care AttendantTaxonomy code 3747P1801X

License

E648516 Issued in WV

Practice address

200 Association Dr Ste 130
Charleston, WV 25311-1277

Phone

(304) 988-4200

NPI assigned

Mar 6, 2023

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

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": "1678060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721260800000",
    "number": "1932809217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 ASSOCIATION DR STE 130",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253111277",
            "telephone_number": "304-988-4200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 ASSOCIATION DR STE 130",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253111277",
            "telephone_number": "304-988-4200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "DENISE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-03-06",
        "last_updated": "2024-07-18",
        "certification_date": "2024-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3747P1801X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician, Personal Care Attendant",
            "state": "WV",
            "license": "E648516",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carrie L Jackson
• Cassie Jackson
• Christina Mae Jackson
• Chynna Rajae Jackson
• David Alexander Jackson, PRSS
• Dominion Alecia Jackson
• Harry Keith Jackson, D.D.S.
• James M Jackson, COUNSELOR 3
• Judy Jackson
• Krystal Jackson

• Personal Care Attendant in Charleston, WV
• Providers in Charleston, WV by specialty
• Personal Care Attendant in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2024; 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.