Kelly Ann Jackson, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

2021028633 Issued in MO

Practice address

1012 N Main St
Sikeston, MO 63801-5097

Phone

(573) 471-0330

Fax

(573) 471-0461

NPI assigned

Dec 15, 2021

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

Other names 1

• Kelly Ann Davis Professional name

Medicare fee-for-service enrollment

Enrolled in MO

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

Group practices

Saint Francis Medical CenterGroup PAC ID 9931007929, 441 clinicians

Health Facilities Rehab Services IncGroup PAC ID 3476679226, 152 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Saint Francis Medical Center Hospital, Cape Girardeau, MO, CCN 260183
• Missouri Delta Medical Center Hospital, Sikeston, MO, CCN 260113

Merit-based Incentive Payment System (MIPS)

Final score

67.07 of 100Reported as apm

Quality

85.4

Promoting interoperability

0

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kjackson11914@surescripts.sfmc.net

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.

• Saint Francis Medical Center

  • Anesthesiology Physician
  • Cape Girardeau, MO
  • NPI 1356304489
  Medicare reassignment Care Compare group NPD
• Health Facilities Rehab Services Inc

  • Rehabilitation Clinic/Center
  • Sikeston, MO
  • NPI 1720003551
  Care Compare group
• Saint Francis Medical Center

  • Rural Health Clinic/Center
  • Sikeston, MO
  • NPI 1588131338
  NPD
• Saint Francis Medical Center

  • Clinic/Center
  • Jackson, MO
  • NPI 1992502975
  NPD
• Saint Francis Medical Center

  • Internal Medicine Physician
  • Cape Girardeau, MO
  • NPI 1578513016
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Missouri Delta Medical Center

  • General Acute Care Hospital
  • Sikeston, MO
  • NPI 1831269539
  Care Compare affiliation
• Saint Francis Medical Center

  • General Acute Care Hospital
  • Cape Girardeau, MO
  • NPI 1467412726
  Care Compare affiliation
• Saint Francis Medical Center

  • Internal Medicine Physician
  • Cape Girardeau, MO
  • NPI 1578513016

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1639526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640131200000",
    "number": "1053070110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 801143",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641801143",
            "telephone_number": "573-331-5583",
            "fax_number": "573-331-5079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1012 N MAIN ST",
            "city": "SIKESTON",
            "state": "MO",
            "postal_code": "638015097",
            "telephone_number": "573-471-0330",
            "fax_number": "573-471-0461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KELLY",
        "middle_name": "ANN",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-15",
        "last_updated": "2021-12-22",
        "certification_date": "2021-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2021028633",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "DAVIS",
            "middle_name": "ANN",
            "credential": "FNP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Ipc Pac Healthcare Services of Missouri Inc
• Jami Lyn Irvan, LMT
• Angela Dawn Jackson, MA, CCC-SLP
• Dorothy Machelle Jackson
• Heather E Jackson
• Lucinda Jakubiak, DPT
• Danielle E Jansen, FNP
• Christy Lea Jaynes, M.A. CCC-SLP
• Rory Jaynes
• Betty Jo Ann Jenkins, MA, PLPC

• Family Nurse Practitioner in Sikeston, MO
• Providers in Sikeston, MO by specialty
• Family Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2021; 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.