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KIESHA JACKSON
NPI 1477127611
Counselor - Mental Health in Inkster, MI

Active since May 13, 2021PECOS Enrolled
30000 HIVELEY ST, INKSTER, MI 48141(313) 218-6832 Get Directions Write a Review

NPPES record last updated: June 16, 2021. Verified against the NPPES registry weekly; last sync: November 08, 2026.

Record update history: Jun 16, 2021, May 13, 2021 (2 updates tracked since 2021).

About Kiesha Jackson NPPES

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

KIESHA JACKSON (NPI 1477127611) is an individual mental health provider in Inkster, Michigan and active in the NPI registry since May 2021. She is enrolled in Medicare PECOS and is a graduate of Other (2022).

NPPES Registry Identity

NPI1477127611
Entity TypeIndividualFemale
Primary Taxonomy101YM0800X
Provider Legal NameKIESHA JACKSON
Location Address30000 HIVELEY STInkster, MI 48141-1089
Mailing Address22200 W 11 Mile Rd Unit 3663Southfield, MI 48037-7107
Phone(313) 218-6832
Sole ProprietorNo
Medical School CMSOtherGraduated 2022
Enumeration DateMay 13, 2021
Last NPPES UpdateJune 16, 20212 updates tracked since enumeration
NPPES CertifiedJune 16, 2021
✔ NPI 1477127611 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
30000 HIVELEY ST, Inkster, MI 48141
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Care Network of Michigan, Blue Cross Blue Shield of Michigan Mutual Insurance Company, McLaren Health Plan Community and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kiesha Jackson is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID2163929399
PECOS Enrollment IDI20251006003547
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.

Medicare Billing Reassignment

Medicare enrollment records show Kiesha Jackson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

A Path To Peace LLC
15 mi
Professional
1010 ANTIETAM AVE
Detroit, MI 48207
  • Reassigned Medicare billing, Michigan enrollment
  • 7 clinicians in this Medicare group
NPI 1083259345 (231) 343-0630

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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.

ANTHONY SCOTT THEEL
Social Worker (Clinical)
30000 HIVELEY ST
INKSTER, MI 48141
Wayne County (734) 728-3400
MICHELLE L. KING
Social Worker
30000 HIVELEY ST
INKSTER, MI 48141
Wayne County (734) 713-9293
LACEY CHRISTINE RUBIN
Social Worker (Clinical)
30000 HIVELEY ST
INKSTER, MI 48141
Wayne County (734) 713-9271
EMILY THIEL
Social Worker (Clinical)
30000 HIVELEY ST
INKSTER, MI 48141
Wayne County (248) 921-2609
SAMANTHA WHITAKER
Occupational Therapist
30000 HIVELEY ST
INKSTER, MI 48141
Wayne County (734) 728-3400
DANITA THOMAS RN
Student in an Organized Health Care Education/Training Program
30000 HIVELEY ST
INKSTER, MI 48141
Wayne County (734) 727-3142
LILLIAN JUNE GREENWOOD
Social Worker (Clinical)
30000 HIVELEY ST
INKSTER, MI 48141
Wayne County (734) 728-3400
CHERICE MOORE
Homemaker
30000 HIVELEY ST
INKSTER, MI 48141
Wayne County (734) 728-3400

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 Kiesha Jackson's NPI number?

The NPI number for Kiesha Jackson is 1477127611. It was assigned to this individual provider in the NPPES registry on May 13, 2021.

Where is Kiesha Jackson located?

Kiesha Jackson practices at 30000 Hiveley St, Inkster, MI 48141. The listed phone number is (313) 218-6832.

What is Kiesha Jackson's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Is Kiesha Jackson enrolled in Medicare?

Yes. Kiesha Jackson is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Kiesha Jackson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kiesha Jackson reassigns Medicare benefits to A Path To Peace LLC (Detroit, MI). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kiesha Jackson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Kiesha Jackson accept?

Health plans from Blue Care Network of Michigan, Blue Cross Blue Shield of Michigan Mutual Insurance Company, McLaren Health Plan Community and Priority Health list Kiesha Jackson as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Kiesha Jackson was last updated on June 16, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.