Nicole Jackson

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

020277 Issued in OH

Practice address

4646 Hilton Corporate Dr
Columbus, OH 43232-4147

Phone

(614) 914-4541

Fax

(614) 866-8580

NPI assigned

Dec 2, 2016

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 OH

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, 2016

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Maumee Valley Guidance Center IncGroup PAC ID 0547293003, 7 clinicians

Mount Carmel Behavioral Healthcare LLCGroup PAC ID 0446595383, 11 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Maumee Valley Guidance Center Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Defiance, OH
  • NPI 1033189642
  Medicare reassignment Care Compare group NPD
• Mount Carmel Behavioral Healthcare, LLC

  • Psychiatric Hospital
  • Columbus, OH
  • NPI 1033693569
  Medicare reassignment Care Compare group NPD
• Lima Memorial Joint Operating Company

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732
  NPD (past)

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

{
    "created_epoch": "1480636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748563200000",
    "number": "1043753403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8483 TORWOODLEE CT # 8483",
            "city": "DUBLIN",
            "state": "OH",
            "postal_code": "430179739",
            "telephone_number": "614-203-8546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4646 HILTON CORPORATE DR",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432324147",
            "telephone_number": "614-914-4541",
            "fax_number": "614-866-8580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-12-02",
        "last_updated": "2025-05-30",
        "certification_date": "2025-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "020277",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OH",
            "license": "020277",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa M Jackson, MSW, LISW
• Michael Jackson
• Michelle Patricia Jackson, RN, MS, APRN-BC
• Monica Jackson
• Nakia Jackson, STNA
• Nicole L. Jackson, PH.D.
• Olivia Jackson
• Pristina Jackson, CPRS
• Rhonda J Jackson
• Selena Jackson, LPN

• Psychiatric/Mental Health Nurse Practitioner in Columbus, OH
• Providers in Columbus, OH by specialty
• Psychiatric/Mental Health Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2025; 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.