Active NPI
Laquisha Lachelle Jackson, REGISTERED NURSE
- Registered Nurse
- Dayton, OH
National Provider Identifier
1962163204
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 412714
- Practice address
- 4699 Salem Ave Ste 1
Dayton, OH 45416-1724 - Phone
- (937) 603-8335
- NPI assigned
- Jan 9, 2022
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 412714 | OH | Primary |
Addresses
Primary practice location
4699 Salem Ave Ste 1
Dayton, OH 45416-1724
Mailing address
4699 Salem Ave Ste 1
Dayton, OH 45416-1724
Phone (937) 603-8335
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | heartoftay@gmail.com | Health Information Exchange (HIE) |
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 |
|---|---|---|---|
| 412714 | OH | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1641686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1641686400000",
"number": "1962163204",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4699 SALEM AVE STE 1",
"city": "DAYTON",
"state": "OH",
"postal_code": "454161724",
"telephone_number": "937-603-8335"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4699 SALEM AVE STE 1",
"city": "DAYTON",
"state": "OH",
"postal_code": "454161724",
"telephone_number": "937-603-8335"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "LAQUISHA",
"middle_name": "LACHELLE",
"credential": "REGISTERED NURSE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-01-09",
"last_updated": "2022-01-09",
"certification_date": "2022-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "OH",
"license": "412714",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "heartoftay@gmail.com",
"affiliation": "N",
"endpointDescription": "Email",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "Email",
"address_1": "4699 Salem Ave Ste 1",
"city": "Dayton",
"state": "OH",
"country_code": "US",
"postal_code": "454161724",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Dayton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.