SHAMICKA JACKSON
NPI 1750764783
Licensed Psychiatric Technician in San Bernardino, CA

Q: What is Shamicka Jackson's NPI number?

The NPI number for Shamicka Jackson is 1750764783. It was assigned to this individual provider in the NPPES registry on July 8, 2015.

Q: What is Shamicka Jackson's specialty?

The primary specialty registered for this NPI is Licensed Psychiatric Technician with taxonomy code 167G00000X.

Q: When was this NPI record last updated?

The NPPES record for Shamicka Jackson was last updated on July 22, 2015. 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 July 08, 2015

2080 S E ST, SAN BERNARDINO, CA 92408(909) 388-9191 Get Directions Write a Review

NPPES record last updated: July 22, 2015. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Shamicka Jackson NPPES

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

SHAMICKA JACKSON (NPI 1750764783) is an individual licensed psychiatric technician in San Bernardino, California, licensed in California (37979) and active in the NPI registry since July 2015.

NPPES Registry Identity

NPI1750764783

Entity TypeIndividualFemale

Primary Taxonomy167G00000X

Provider Legal NameSHAMICKA JACKSON

Location Address2080 S E STSan Bernardino, CA 92408-2773

Mailing Address2080 S E StSan Bernardino, CA 92408-2773 · (909) 388-9191

Phone(909) 388-9191

Sole ProprietorNo

Enumeration DateJuly 8, 2015

Last NPPES UpdateJuly 22, 2015

✔ NPI 1750764783 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyLicensed Psychiatric TechnicianNursing Service Providers

Taxonomy Code167G00000X

License✔ Licensed in CA · 37979

Definition

An individual licensed by the state board as a Psychiatric Technician based upon completion of a prescribed course of theory and clinical practice, with two thirds of the clinical practice time focused on mental and developmental disorders. The psychiatric technician practices under the direct supervision of a physician, psychologist, registered nurse or other professional to provide care to patients with mental disorders and developmental disabilities.

2080 S E ST, San Bernardino, CA 92408

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Other Identifiers 1

Medicaid1760651178CA

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.

JOHNNY TAMAS

Licensed Psychiatric Technician