=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427994557
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE KRISTIAN JACOB AUTISM CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/29/2026
-----------------------------------------------------
Last Update Date | 04/29/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3010 BRISBANE LN
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39204-4101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 769-226-1981
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3010 BRISBANE LN
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39204-4101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 769-226-1981
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | YOLANDA LANGSTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 601-940-2793
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD1600X
-----------------------------------------------------
Taxonomy Name | Developmental Disabilities Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------