Active NPI
Annie Marie Jackson, LMSW
- Social Worker
- Southaven, MS
National Provider Identifier
1952008120
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- M8955
- Practice address
- 8549 Southaven Cir W
Southaven, MS 38671-2919 - Phone
- (662) 721-0814
- NPI assigned
- Feb 8, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 13907 | TN | |
| Social Worker | 104100000X | M8955 | MS | Primary |
Addresses
Primary practice location
8549 Southaven Cir W
Southaven, MS 38671-2919
Mailing address
8549 Southaven Cir W
Southaven, MS 38671-2919
Phone (662) 721-0814
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M8955 | MS | MD | Social Worker |
| 13907 | TN | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1675814400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1675814400000",
"number": "1952008120",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8549 SOUTHAVEN CIR W",
"city": "SOUTHAVEN",
"state": "MS",
"postal_code": "386712919",
"telephone_number": "662-721-0814"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8549 SOUTHAVEN CIR W",
"city": "SOUTHAVEN",
"state": "MS",
"postal_code": "386712919",
"telephone_number": "662-721-0814"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "ANNIE",
"middle_name": "MARIE",
"credential": "LMSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-02-08",
"last_updated": "2023-02-08",
"certification_date": "2023-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "TN",
"license": "13907",
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MS",
"license": "M8955",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southaven, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.