Kimberly A Jackson, PMHNP, FNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

403954 Issued in NY

Practice address

266 Broadway Ste 401
Brooklyn, NY 11211-6306

Phone

(347) 696-1375

Fax

(914) 222-8973

NPI assigned

Oct 4, 2010

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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.

• Orange Family Health NP PLLC

  • Medical Specialty Clinic/Center
  • Mahopac, NY
  • NPI 1770086787
  NPD Authorized official
• Well Space Nurse Practitioner in Psychiatry and Family Health PLLC

  • Medical Specialty Clinic/Center
  • Brooklyn, NY
  • NPI 1184376055
  NPD Authorized official
• The Westchester Medical Practice, PC

  • Multi-Specialty Clinic/Center
  • Cortlandt Manor, NY
  • NPI 1982109120
  NPD (past)

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

{
    "created_epoch": "1286150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769644800000",
    "number": "1083923353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "266 BROADWAY STE 401",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112116306",
            "telephone_number": "347-696-1375",
            "fax_number": "914-222-8973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "266 BROADWAY STE 401",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112116306",
            "telephone_number": "347-696-1375",
            "fax_number": "914-222-8973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KIMBERLY",
        "middle_name": "A",
        "name_prefix": "Ms.",
        "credential": "PMHNP, FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-10-04",
        "last_updated": "2026-01-29",
        "certification_date": "2026-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "336506",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CT",
            "license": "12.007638",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "403954",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Judith A Jackson
• Kaedrea Jackson, M.D.
• Kathleen Elizabeth Jackson, MSW
• Keanu Maliq Jackson, LCSW
• Kim Janice Jackson
• Kristina Ashley Jackson, PSYD
• Lashanda M Jackson
• Leslie J Jackson, LCSW
• Lindsey Renae Jackson
• Lisa Nicole Jackson, LPN

• Psychiatric/Mental Health Nurse Practitioner in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Psychiatric/Mental Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2026; 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.