MR. NYLES ANTONY JACKSON MSW, APSW, SAC-IT
NPI 1053637629
Social Worker in Kenosha, WI

Q: What is Nyles Jackson's NPI number?

The NPI number for Nyles Jackson is 1053637629. It was assigned to this individual provider in the NPPES registry on April 7, 2010.

Q: What is Nyles Jackson's specialty?

The primary specialty registered for this NPI is Social Worker with taxonomy code 104100000X.

Q: When was this NPI record last updated?

The NPPES record for Nyles Jackson was last updated on April 7, 2010. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since April 07, 2010PECOS Enrolled

4109 67TH ST, KENOSHA, WI 53142(262) 652-9830(262) 652-2931 Get Directions Write a Review

NPPES record last updated: April 7, 2010. Verified against the NPPES registry weekly; last sync: July 26, 2026.

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About Mr. Nyles Antony Jackson Msw, Apsw, Sac-it NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. NYLES ANTONY JACKSON MSW, APSW, SAC-IT (NPI 1053637629) is an individual social worker in Kenosha, Wisconsin, licensed in Wisconsin (128033-121) and active in the NPI registry since April 2010. He is enrolled in Medicare PECOS and is a graduate of Other (2009).

NPPES Registry Identity

NPI1053637629

Entity TypeIndividualMale

Primary Taxonomy104100000X

Provider Legal NameMR. NYLES ANTONY JACKSONCredential: MSW, APSW, SAC-IT

Location Address4109 67TH STKenosha, WI 53142-3836

Mailing Address4109 67th StKenosha, WI 53142-3836 · (262) 652-9830 · Fax (262) 652-2931

Phone(262) 652-9830

Fax(262) 652-2931

Sole ProprietorNo

Medical School CMSOtherGraduated 2009

Enumeration DateApril 7, 2010

✔ NPI 1053637629 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtySocial WorkerBehavioral Health & Social Service Providers

Taxonomy Code104100000X

License✔ Licensed in WI · 128033-121

Definition

A social worker is a person who is qualified by a Social Work degree, and licensed, certified or registered by the state as a social worker to practice within the scope of that license. A social worker provides assistance and counseling to clients and their families who are dealing with social, emotional and environmental problems. Social work services may be rendered to individuals, families, groups, and the public.

Also ListedCounselor · Addiction (Substance Use Disorder)Taxonomy 101YA0400X · License 15877-130 (WI)

4109 67TH ST, Kenosha, WI 53142

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mr. Nyles Antony Jackson Msw, Apsw, Sac-it is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID7810204708

PECOS Enrollment IDI20150909001658

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JEANNIE SEEFELDT CSW, CADC III

Counselor (Addiction (Substance Use Disorder))