Dr Jackie D Nickson, OTD, OTR/L is a
Occupational Therapist based in Horn Lake, Mississippi. Dr Jackie D Nickson is licensed to practice in Mississippi (license number OT1986) and her current practice location is
6664 Sinclair Dr, Horn Lake, Mississippi. She can be reached at her office (for appointments etc.) via phone at
(901) 230-4982.
NPI number for Dr Jackie D Nickson is 1356777411 and her current mailing address is 6664 Sinclair Dr, Horn Lake, Mississippi. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1356777411.
Healthcare Provider's Profile
| Full Name | Dr Jackie D Nickson |
|---|
| Gender | Female |
|---|
| Speciality | Occupational Therapist |
|---|
| Location | 6664 Sinclair Dr, Horn Lake, Mississippi |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1356777411
- Provider Enumeration Date: 09/20/2013
- Last Update Date: 01/12/2014
Medical Identifiers
Medical identifiers for Dr Jackie D Nickson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1356777411 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 225X00000X | Occupational Therapist | OT1986 (Mississippi) | Primary |
| 225X00000X | Occupational Therapist | 1986 (Mississippi) | Secondary |
| 225100000X | Physical Therapist | (Mississippi) | Secondary |
| 235Z00000X | Speech-language Pathologist | (Mississippi) | Secondary |
| 224Z00000X | Occupational Therapy Assistant | (Mississippi) | Secondary |
| 225200000X | Physical Therapy Assistant | (Mississippi) | Secondary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Jackie D Nickson is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Jackie D Nickson, OTD, OTR/L
6664 Sinclair Dr,
Horn Lake, MS 38637-2598
Ph: (901) 230-4982 | Dr Jackie D Nickson, OTD, OTR/L
6664 Sinclair Dr,
Horn Lake, MS 38637-2598
Ph: (901) 230-4982 |
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