Dr Lynisha Kelly-jackson, PHD, LP, LSSP, NCS is a
Psychologist based in Polk City, Florida. Dr Lynisha Kelly-jackson is licensed to practice in Texas (license number 38090) and her current practice location is
992 Montgomery Ln, Polk City, Florida. She can be reached at her office (for appointments etc.) via phone at
(813) 638-5836.
NPI number for Dr Lynisha Kelly-jackson is 1891491296 and her current mailing address is 992 Montgomery Ln, Polk City, Florida. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1891491296.
Healthcare Provider's Profile
| Full Name | Dr Lynisha Kelly-jackson |
|---|
| Gender | Female |
|---|
| Speciality | Psychologist |
|---|
| Location | 992 Montgomery Ln, Polk City, Florida |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1891491296
- Provider Enumeration Date: 02/07/2023
- Last Update Date: 02/07/2023
Medical Identifiers
Medical identifiers for Dr Lynisha Kelly-jackson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1891491296 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 103TS0200X | Psychologist - School | 70907 (Texas) | Secondary |
| 103T00000X | Psychologist | 38090 (Texas) | Primary |
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 Lynisha Kelly-jackson 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 Lynisha Kelly-jackson, PHD, LP, LSSP, NCS
992 Montgomery Ln,
Polk City, FL 33868-9097
Ph: (813) 638-5836 | Dr Lynisha Kelly-jackson, PHD, LP, LSSP, NCS
992 Montgomery Ln,
Polk City, FL 33868-9097
Ph: (813) 638-5836 |
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