MR. OTIS JACKSON JR.
NPI 1053710681
Psychologist - Adult Development & Aging in Memphis, TN

Q: What is Otis Jackson's NPI number?

The NPI number for Otis Jackson is 1053710681. It was assigned to this individual provider in the NPPES registry on August 20, 2014.

Q: What is Otis Jackson's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Adult Development & Aging, with taxonomy code 103TA0700X.

Q: When was this NPI record last updated?

The NPPES record for Otis Jackson was last updated on August 20, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since August 20, 2014

3311 KIMBALL AVE, MEMPHIS, TN 38111(901) 207-4662 Get Directions Write a Review

NPPES record last updated: August 20, 2014. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Mr. Otis Jackson Jr. NPPES

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

MR. OTIS JACKSON JR. (NPI 1053710681) is an individual adult development & aging provider in Memphis, Tennessee, licensed in Tennessee (1000000015105) and active in the NPI registry since August 2014.

NPPES Registry Identity

NPI1053710681

Entity TypeIndividualMale

Primary Taxonomy103TA0700X

Provider Legal NameMR. OTIS JACKSON JR.

Location Address3311 KIMBALL AVEMemphis, TN 38111-3846

Mailing Address1092 Center Ridge RdCollierville, TN 38017-9207 · (901) 870-6847 · Fax (901) 854-9779

Phone(901) 207-4662

Sole ProprietorNo

Enumeration DateAugust 20, 2014

✔ NPI 1053710681 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · Adult Development & AgingBehavioral Health & Social Service Providers

Taxonomy Code103TA0700X

License✔ Licensed in TN · 1000000015105

Definition

A psychologist who specializes in geropsychology, which applies the knowledge and methods of psychology to understanding and helping older persons and their families to maintain well-being, overcome problems and achieve maximum potential during later life. Professional geropsychology appreciates the wide diversity among older adults, the complex ethical issues that can arise in geriatric practice and the importance of interdisciplinary models of care.

3311 KIMBALL AVE, Memphis, TN 38111

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Other Providers at the Same Location NPPES

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

WRIGHT ENHANCEMENT CENTER

Psychologist (Adult Development & Aging)

3311 KIMBALL AVE
MEMPHIS, TN 38111

Shelby County (901) 207-4662

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Otis Jackson's NPI number?

The NPI number for Otis Jackson is 1053710681. It was assigned to this individual provider in the NPPES registry on August 20, 2014.

Where is Otis Jackson located?

Otis Jackson practices at 3311 Kimball Ave, Memphis, TN 38111. The listed phone number is (901) 207-4662.

What is Otis Jackson's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Adult Development & Aging, with taxonomy code 103TA0700X.

When was this NPI record last updated?

The NPPES record for Otis Jackson was last updated on August 20, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.