Shauntorya Jackson, AGNP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

AP128145 Issued in TX

Practice address

2281 Olympia Dr
Suite 100
Flower Mound, TX 75028-1857

Phone

(469) 322-0089

NPI assigned

Sep 28, 2015

Last updated

Jul 5, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

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, 2014

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Advanced Wound Care of North Texas PLLCGroup PAC ID 7315276599, 5 clinicians

Long Term Health Careline CorpGroup PAC ID 2264882950, 10 clinicians

Cardio and Renal Therapeutics of North Texas PLLCGroup PAC ID 7810329638, 32 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sjackson135184@direct.phhs.org

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.

• Advanced Wound Care of North Texas PLLC

  • Family Medicine Physician
  • Dallas, TX
  • NPI 1366908600
  Medicare reassignment Care Compare group NPD
• Long Term Health Careline Corp

  • Internal Medicine Physician
  • Arlington, TX
  • NPI 1588378830
  Medicare reassignment Care Compare group NPD
• Cardio & Renal Therapeutics of North Texas PLLC

  • Nephrology Physician
  • Sherman, TX
  • NPI 1649813296
  Medicare reassignment Care Compare group
• Lonestar Hospital Medicine Associates, PA

  • Hospitalist Physician
  • Mansfield, TX
  • NPI 1518237429
  Medicare reassignment NPD
• LTHC Solutions LLC

  • Internal Medicine Physician
  • Arlington, TX
  • NPI 1194182543
  Medicare reassignment NPD
• Kunik Health, PA

  • Internal Medicine Physician
  • Flower Mound, TX
  • NPI 1750550778
  Medicare reassignment
• Mercy Hospice, LTD

  • Community Based Hospice Care Agency
  • Flower Mound, TX
  • NPI 1790885978
  NPD (past)

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

{
    "created_epoch": "1443398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688515200000",
    "number": "1104296615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2281 OLYMPIA DR",
            "address_2": "SUITE 100",
            "city": "FLOWER MOUND",
            "state": "TX",
            "postal_code": "750281857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2281 OLYMPIA DR",
            "address_2": "SUITE 100",
            "city": "FLOWER MOUND",
            "state": "TX",
            "postal_code": "750281857",
            "telephone_number": "469-322-0089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SHAUNTORYA",
        "name_prefix": "Mrs.",
        "credential": "AGNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-28",
        "last_updated": "2023-07-05",
        "certification_date": "2023-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "AP128145",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "TX",
            "license": "AP128145",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Osaru Iyamu, LVN
• J. David Evanich, M.D. PA
• Ja Biblical Counseling, PLLC
• Javaria Jabeen, DO
• Amanda Jackson, BT
• Mikayla L Jacob
• Akshaya Jain, M.D.
• Saira Jamal, M.D
• James R Heerwagen MD PA
• Jeni James, CCC-SLP

• Gerontology Nurse Practitioner in Flower Mound, TX
• Providers in Flower Mound, TX by specialty
• Gerontology Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2023; 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.