Provider Demographics
NPI:1134013816
Name:JACKSON, KIARA LASHANTAE (MSW)
Entity type:Individual
Prefix:MS
First Name:KIARA
Middle Name:LASHANTAE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3748 FRONTERA CIR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32505-7301
Mailing Address - Country:US
Mailing Address - Phone:850-512-2482
Mailing Address - Fax:
Practice Address - Street 1:3748 FRONTERA CIR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32505-7301
Practice Address - Country:US
Practice Address - Phone:850-512-2482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL217561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical