MARISSA CAYENNE JACKSON — NPI 1093697666 (Licensed & Credentialed Doula in CAIRO, IL)

CMS-1500 Box 24J / 33a • NPI

1093697666

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

374J00000X

Licensed & Credentialed Doula

Box 32 Service Location & ZIP+4

13245 KESSLER RD, CAIRO, IL, 62914-3101

✓ 9-Digit EDI 837 ZIP+4 (62914-3101)

Practice Phone & Referral Fax

(618) 734-4400

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1093697666 (MARISSA CAYENNE JACKSON) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1093697666` (NPI-1 Individual Practitioner)
Provider / Legal Name	MARISSA CAYENNE JACKSON
Plain-English Specialty	Licensed & Credentialed Doula NUCC Code: `374J00000X` (Doula)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	13245 KESSLER RD, CAIRO, IL, 62914-3101
Practice Telephone / Fax	Tel: (618) 734-4400
Administrative Mailing Address	1412 MOUNDS RD, MOUNDS, IL, 62964-2305
Enumeration & Last Sync	Enumerated: 2025-07-23 \| CMS Record Updated: 2026-09-29

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

13245 KESSLER RD, CAIRO, IL, 62914-3101

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Plain-English Taxonomy & CMS Crosswalk (374J00000X)

What Does Taxonomy Code 374J00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 374J00000X translates to:
"Licensed & Credentialed Doula"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Doula for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (MARISSA CAYENNE JACKSON)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`374J00000X` — Doula Plain English: Licensed & Credentialed Doula	State: IL \| License: `MJ25` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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MARISSA CAYENNE JACKSON (NPI #1093697666)