Kevin D. Jackson

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

0002724 Issued in OH

Practice address

502 S High St Apt D
Yellow Springs, OH 45387-1565

Phone

(937) 287-5353

NPI assigned

Sep 29, 2021

Last updated

Sep 29, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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": "1632873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632873600000",
    "number": "1982376943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751",
            "city": "YELLOW SPRINGS",
            "state": "OH",
            "postal_code": "453870751",
            "telephone_number": "937-287-5353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "502 S HIGH ST APT D",
            "city": "YELLOW SPRINGS",
            "state": "OH",
            "postal_code": "453871565",
            "telephone_number": "937-287-5353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KEVIN",
        "middle_name": "D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-09-29",
        "last_updated": "2021-09-29",
        "certification_date": "2021-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "OH",
            "license": "0002724",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura Sue Hunnibell, APRN
• Tracy L Hunt, LPCC
• David E Hyde, MD
• Flora E Igah
• Jennifer L Instine, LSW
• Jeanne Parr Lemkau, PH.D., LLC
• Deborah Jerison
• Celia Rose Jones
• Paul Kadis, PSY.D.
• Michele Rose Kattine, LSW

• Peer Specialist in Yellow Springs, OH
• Providers in Yellow Springs, OH by specialty
• Peer Specialist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 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.