Jacqualine Drake Dickson, FNP - C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

APN0000024154 Issued in TN

Practice address

526 Halle Park Dr
Collierville, TN 38017-7085

Phone

(901) 910-3246

NPI assigned

Mar 11, 2019

Last updated

Feb 19, 2021By 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 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

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, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Consolidated Medical Practices of Memphis,PLLCGroup PAC ID 1759459845, 113 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Baptist Memorial Hospital Hospital, Memphis, TN, CCN 440048
• Methodist Hospitals of Memphis Hospital, Memphis, TN, CCN 440049

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/IBHBDD

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.

• Consolidated Medical Practices of Memphis,PLLC

  • Internal Medicine Physician
  • Memphis, TN
  • NPI 1508027491
  Medicare reassignment Care Compare group NPD
• Margaret Henderson-Lee, FNP-BC

  • Family Nurse Practitioner
  • Germantown, TN
  • NPI 1952629180
  Medicare reassignment
• Internal Health and Medical Services LLC

  • Geriatric Medicine (Family Medicine) Physician
  • Cordova, TN
  • NPI 1215569207
  NPD
• Margaret Lashun Henderson-Lee

  dba Internal Health and Medical Services

  • Geriatric Medicine (Family Medicine) Physician
  • Germantown, TN
  • NPI 1124455373
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Baptist Memorial Hospital

  • General Acute Care Hospital
  • Memphis, TN
  • NPI 1578527172
  Care Compare affiliation
• Methodist Healthcare - Memphis Hospitals

  dba Le Bonheur Children's Hospital

  • Children's Hospital
  • Memphis, TN
  • NPI 1386709871
  Care Compare affiliation
• Methodist Healthcare - Memphis Hospitals

  • General Acute Care Hospital
  • Memphis, TN
  • NPI 1558365890
  Care Compare affiliation
• Methodist Healthcare - Memphis Hospitals

  dba Le Bonheur Children's Hospital - Germantown

  • Children's Hospital
  • Germantown, TN
  • NPI 1649654450
  Care Compare affiliation

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

{
    "created_epoch": "1552262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613692800000",
    "number": "1124586995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8418 REGAL BEND DR",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386544415",
            "telephone_number": "662-512-2237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "526 HALLE PARK DR",
            "city": "COLLIERVILLE",
            "state": "TN",
            "postal_code": "380177085",
            "telephone_number": "901-910-3246"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "491 W Poplar Ave",
            "address_purpose": "LOCATION",
            "city": "Collierville",
            "state": "TN",
            "postal_code": "380172537",
            "country_code": "US",
            "telephone_number": "901-861-0001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DICKSON",
        "first_name": "JACQUALINE",
        "middle_name": "DRAKE",
        "credential": "FNP - C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-03-11",
        "last_updated": "2021-02-19",
        "certification_date": "2021-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "APN0000024154",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "902387",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dental Implant Aesthetic Center (Oral and Facial Surgical Specialists)
• Dwana Jeane Desanctis, PT
• Jill Suzanne Detty Oswaks, DNSC
• Matthew Zane Devazier
• Phyllis A Dickinson-Branch, DDS
• Nicholas Alexander Diloreto
• Jeffrey A Dlabach, M.D.
• Nicole D Dotson
• Mia Star Douglas
• Dr Mark Lynn & Associates PLLC (Visionworks Doctors of Optometry)

• Family Nurse Practitioner in Collierville, TN
• Providers in Collierville, TN by specialty
• Family Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 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.
• 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.