Active NPI
Kimcheree Jackson
- Nurse Practitioner
- Sanford, FL
National Provider Identifier
1083093355
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- ARNP9250679
- Practice address
- 4930 E Lake Mary Blvd
Sanford, FL 32771-5003 - Phone
- (407) 322-8645
- NPI assigned
- May 20, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | ARNP9250679 | FL | Primary |
Addresses
Primary practice location
4930 E Lake Mary Blvd
Sanford, FL 32771-5003
Mailing address
4930 E Lake Mary Blvd
Sanford, FL 32771-5003
Phone (407) 322-8645
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
10415 Moss Park Rd
Orlando, FL 32832-5812
Phone (407) 737-2751
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
Organizations & group practices 4
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.
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- Altamonte Springs, FL
- NPI 1740275635
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1432080000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1588204800000",
"number": "1083093355",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4930 E LAKE MARY BLVD",
"city": "SANFORD",
"state": "FL",
"postal_code": "327715003",
"telephone_number": "407-322-8645"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4930 E LAKE MARY BLVD",
"city": "SANFORD",
"state": "FL",
"postal_code": "327715003",
"telephone_number": "407-322-8645"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "KIMCHEREE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-05-20",
"last_updated": "2020-04-30",
"certification_date": "2020-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "FL",
"license": "ARNP9250679",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sanford, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 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.