Lillia Jackson, NURSE

Primary specialty

Licensed Vocational NurseTaxonomy code 164X00000X

License

VN264697 Issued in CA

Practice address

1235 McHenry Ave Ste Aandb
Modesto, CA 95350-5370

Phone

(209) 527-4597

NPI assigned

Feb 26, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1645833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645833600000",
    "number": "1013663285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1235 MCHENRY AVE STE AANDB",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953505370",
            "telephone_number": "209-527-4597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1235 MCHENRY AVE STE AANDB",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953505370",
            "telephone_number": "209-527-4597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "LILLIA",
        "credential": "NURSE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-26",
        "last_updated": "2022-02-26",
        "certification_date": "2022-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "VN264697",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charlene Marie Jackson
• Dawn Jackson
• Jaila Yayera Jackson
• Jessica Erin Jackson, RRT
• Jolyn Jackson, HS DIPLOMA
• Lynette Jackson
• Markus Jackson, M.D.
• Roger M Jackson
• Shanisha Jackson
• George I Jacob, D.C.

• Licensed Vocational Nurse in Modesto, CA
• Providers in Modesto, CA by specialty
• Licensed Vocational Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.