Provider Demographics
NPI:1255120622
Name:JACKSON, KIMBERLY TAYLOR (MA, LPA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:TAYLOR
Last Name:JACKSON
Suffix:
Gender:
Credentials:MA, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CHURCH RD APT B
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-2059
Mailing Address - Country:US
Mailing Address - Phone:910-280-8381
Mailing Address - Fax:
Practice Address - Street 1:9 W SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-0047
Practice Address - Country:US
Practice Address - Phone:828-670-8056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6554103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist