Anita Marie Jackson, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

PN318856 Issued in PA

Practice address

3200 Kilburn Rd
Philadelphia, PA 19114-1107

Phone

(215) 964-4492

NPI assigned

Sep 18, 2023

Last updated

Sep 18, 2023By 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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1694995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694995200000",
    "number": "1083492557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 KILBURN RD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191141107",
            "telephone_number": "215-964-4492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 KILBURN RD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191141107",
            "telephone_number": "215-964-4492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ANITA",
        "middle_name": "MARIE",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-09-18",
        "last_updated": "2023-09-18",
        "certification_date": "2023-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "PA",
            "license": "PN318856",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aaron Jackson
• Alyce Jackson, PH.D.
• Amanda Emily Jackson, C.R.N.P
• Andrea Arnita Jackson, CRNP
• Andrea L Jackson, CRNP
• Anna Jackson
• Ateeya Jackson, NURSE PRACTITIONER
• Bertha Adele Jackson, CRNP
• Biancha Jackson, MHSC, RD
• Cameron Lauren Jackson

• Licensed Practical Nurse in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Licensed Practical Nurse in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.