Brandi Jackson, CRNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1-108915 Issued in AL

Practice address

Tennessee Valley Pediatrics
234 Keller Park
Tuscumbia, AL 35674

Phone

(256) 381-6963

NPI assigned

Aug 14, 2020

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

Enrolled in AL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Avalon Medical GroupGroup PAC ID 3678566189, 22 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Avalon Medical Group

  • Internal Medicine Physician
  • Muscle Shoals, AL
  • NPI 1730149071
  Medicare reassignment Care Compare group
• Tennessee Valley Pediatric Associatesinc.

  • Pediatrics Physician
  • Tuscumbia, AL
  • NPI 1043323439
  NPD (past)

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

{
    "created_epoch": "1597363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597363200000",
    "number": "1033720701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5551 COUNTY ROAD 63",
            "city": "KILLEN",
            "state": "AL",
            "postal_code": "35645",
            "telephone_number": "256-710-7277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "TENNESSEE VALLEY PEDIATRICS",
            "address_2": "234 KELLER PARK",
            "city": "TUSCUMBIA",
            "state": "AL",
            "postal_code": "35674",
            "telephone_number": "256-381-6963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "BRANDI",
        "name_prefix": "Mrs.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-14",
        "last_updated": "2020-08-14",
        "certification_date": "2020-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "1-108915",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Margaret Holmes, PHARMD
• Alisha Danielle Holt, DO
• D'Arcy Hughes, CRNP
• Lindsay Humphreys, FNP-C
• Matthew Peter Ithurburn, DPT
• James T. Gardiner Family Dentistry, P.C.
• Anna Margaret James, NP
• Erica Lynne Jantzen, CRNP
• Anna Grace Jeffreys, BCBA, LBA
• Ivee G Jenkins

• Family Nurse Practitioner in Tuscumbia, AL
• Providers in Tuscumbia, AL by specialty
• Family Nurse Practitioner in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.