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NPI Code Detail

MEDICARE: NATHANIEL JACKSON

MEDICARE: NATHANIEL JACKSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT-26-530076MO

General Provider Information

NPI Number : 1831033265
Entity Type Code : Individual
Provider Name (Legal Business Name) : NATHANIEL JACKSON
Provider Business Mailing Address
First Line : 4400 DR MARTIN LUTHER KING JR BLVD
Second Line :
City : KANSAS CITY
State : MO
Zip : 64130-2870
Country : US
Telephone Number : 816-994-5693
Fax Number :
Provider Business Practice Location Address
First Line : 4400 DR MARTIN LUTHER KING JR BLVD
Second Line :
City : KANSAS CITY
State : MO
Zip : 64130-2870
Country : US
Telephone Number : 816-994-5693
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2026
Last Update Date : 04/16/2026

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Directions to “ NATHANIEL JACKSON ” Practice Location

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