Kimberly Jackson

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

SP024265 Issued in PA

Practice address

1402 Penn Ave
Pittsburgh, PA 15221-2413

Phone

(412) 224-9534

NPI assigned

Aug 18, 2021

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

Other names 1

• Kimberly Millender Former name

Medicare fee-for-service enrollment

Enrolled in PA

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

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.

• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863

  PA

  Medicare reassignment NPD
• Caring With a Heart Group Home Services LLC

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Pittsburgh, PA
  • NPI 1356207005
  NPD Authorized official

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

{
    "created_epoch": "1629244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629244800000",
    "number": "1083380125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1402 PENN AVE",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152212413",
            "telephone_number": "412-224-9534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1402 PENN AVE",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152212413",
            "telephone_number": "412-224-9534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KIMBERLY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-08-18",
        "last_updated": "2021-08-18",
        "certification_date": "2021-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "PA",
            "license": "SP024265",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "MILLENDER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jaimaya Jackson
• Joann Jackson, CRNP
• Jonathan Matthew Jackson, DDS
• Kathryn M. Jackson
• Kesha Jackson, LPC
• Koren Jackson, CCC-SLP
• Kyle Lynne Jackson
• Kyle Robert Jackson, PA
• Laura Elizabeth Evans Jackson, MD
• Lindsay Jackson

• Primary Care Nurse Practitioner in Pittsburgh, PA
• Providers in Pittsburgh, PA by specialty
• Primary Care Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.