Kristie Lynn Jackson, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

0024167104 Issued in VA

Practice address

3700 South Main Street
Blacksburg, VA 24060

Phone

(540) 953-5385

NPI assigned

Oct 5, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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 VA

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, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wildwood Emergency Group, LLCGroup PAC ID 4789932385, 35 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wildwood Emergency Group, LLC

  • Emergency Medicine Physician
  • Blacksburg, VA
  • NPI 1013409721
  Medicare reassignment Care Compare group NPD
• Kingsford Emergency Group, LLC

  • Emergency Medicine Physician
  • Pulaski, VA
  • NPI 1336631480
  Medicare reassignment NPD
• Kingsford Physician Services, LLC

  • Hospitalist Physician
  • Pulaski, VA
  • NPI 1871088526
  Medicare reassignment NPD
• Lake Spring Emergency Group, LLC

  • Emergency Medicine Physician
  • Salem, VA
  • NPI 1215429600
  Medicare reassignment NPD
• Emergency Coverage Services, PC

  • Nurse Practitioner
  • Lawrenceburg, TN
  • NPI 1053351593

  VA

  Medicare reassignment NPD
• Braeburn Emergency Physicians LLC

  • Emergency Medicine Physician
  • Salem, VA
  • NPI 1467888263
  NPD (past)

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1053407817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 MUDPIKE ROAD",
            "city": "CHRISTIANSBURG",
            "state": "VA",
            "postal_code": "24073",
            "telephone_number": "540-382-9139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3700 SOUTH MAIN STREET",
            "city": "BLACKSBURG",
            "state": "VA",
            "postal_code": "24060",
            "telephone_number": "540-953-5385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KRISTIE",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024167104",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Internal Medicine of Blacksburg LLC
• Sadia Iqbal, DO
• Carissa L Isbell, PHARM. D.
• Ischemic Injured Organs and Limbs Foundation
• Hannah Jacqueline Jackson, PTA
• Lukas Jackson, DPT
• Minna R Jackson, LPC
• William Materson Jackson, CRNFA
• Megan Jacobs
• Steve E Jacobs, OD

• Family Nurse Practitioner in Blacksburg, VA
• Providers in Blacksburg, VA by specialty
• Family Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.