MEDICARE: NEKKESIA 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
1	104100000X	Social Worker	CSW00001424	KY

General Provider Information

NPI Number	:	1891629994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEKKESIA JACKSON

Provider Business Mailing Address
First Line	:	8803 FURLONG DR APT 10
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40242-7504
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2801 VIRGINIA AVE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40211-3418
Country	:	US
Telephone Number	:	502-963-5677
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2026
Last Update Date	:	06/11/2026

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Directions to “ NEKKESIA JACKSON ” Practice Location

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