Seolar L Jackson, PMNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

403929 Issued in NY

Practice address

768 Delaware Ave
Buffalo, NY 14209-2006

Phone

(716) 882-3151

Fax

(716) 886-4002

NPI assigned

May 7, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Bestself Behavioral Health IncGroup PAC ID 6507856622, 77 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Bestself Behavioral Health, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Buffalo, NY
  • NPI 1508868407
  Medicare reassignment Care Compare group NPD
• County of Niagara

  • Community/Behavioral Health Agency
  • Lockport, NY
  • NPI 1891832879
  Medicare reassignment
• Bestself Behavioral Health, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Buffalo, NY
  • NPI 1023230695
  NPD
• Bestself Behavioral Health, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Orchard Park, NY
  • NPI 1891907507
  NPD
• Interim Health Care

  • Nursing Care Agency
  • Buffalo, NY
  • NPI 1801337993
  NPD (past)

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

{
    "created_epoch": "1430956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667952000000",
    "number": "1043698384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2605 SWEET HOME RD",
            "city": "AMHERST",
            "state": "NY",
            "postal_code": "142282129",
            "telephone_number": "716-444-8635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "768 DELAWARE AVE",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142092006",
            "telephone_number": "716-882-3151",
            "fax_number": "716-886-4002"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "69 Delaware Ave",
            "address_2": "Suite 1200",
            "address_purpose": "LOCATION",
            "city": "Buffalo",
            "state": "NY",
            "postal_code": "142023812",
            "country_code": "US",
            "telephone_number": "716-852-5900",
            "fax_number": "716-852-5913",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3350 Main St",
            "address_purpose": "LOCATION",
            "city": "Buffalo",
            "state": "NY",
            "postal_code": "142141316",
            "country_code": "US",
            "telephone_number": "716-835-4011",
            "fax_number": "716-835-0253",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SEOLAR",
        "middle_name": "L",
        "credential": "PMNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-07",
        "last_updated": "2022-11-09",
        "certification_date": "2022-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "621214",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "403929",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laurletha Renay Jackson
• Melissa Rae Jackson
• Natasha Jackson
• Patricia Jackson, CRNA
• Roseanne Johnson Jackson
• Shayla N Jackson
• Tamika Marie Jackson, NP-C
• Fatima Marie Jacksonedge, RN
• Sandra Marcey Jacob, NP
• Kimberly Jacobbi A Jacobbi, COTA

• Psychiatric/Mental Health Nurse Practitioner in Buffalo, NY
• Providers in Buffalo, NY by specialty
• Psychiatric/Mental Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2022; 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.