Active NPI
Kelly Nicole Jackson, PTA
- Physical Therapy Assistant
- Omaha, NE
National Provider Identifier
1033365002
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- NE733
- Practice address
- 2085 N 120TH St
Suite D8
Omaha, NE 68164-3479 - Phone
- (402) 445-4335
- Fax
- (402) 445-6162
- NPI assigned
- Aug 11, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | NE733 | NE | Primary |
Addresses
Primary practice location
2085 N 120TH St
Suite D8
Omaha, NE 68164-3479
Mailing address
8464 Orchard Ave
Omaha, NE 68127-2606
Phone (402) 960-9964
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NE733 | NE | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Moving Well Physical Therapy Limited Partnership | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapy Clinic/Center
- Omaha, NE
- NPI 1639117682
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1218412800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1218412800000",
"number": "1033365002",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8464 ORCHARD AVE",
"city": "OMAHA",
"state": "NE",
"postal_code": "681272606",
"telephone_number": "402-960-9964",
"fax_number": "402-445-6162"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2085 N 120TH ST",
"address_2": "SUITE D8",
"city": "OMAHA",
"state": "NE",
"postal_code": "681643479",
"telephone_number": "402-445-4335",
"fax_number": "402-445-6162"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "KELLY",
"middle_name": "NICOLE",
"name_prefix": "Miss",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-08-11",
"last_updated": "2008-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "NE",
"license": "NE733",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.