Kimberley Evelyn Jackson, D.O.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

OS014960 Issued in PA

Practice address

902 Lakeview Ave
Pueblo, CO 81004-3597

Phone

(719) 557-5855

Fax

(719) 557-4690

NPI assigned

Jul 22, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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

{
    "created_epoch": "1216684800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316131200000",
    "number": "1154586832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "902 LAKEVIEW AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810043597",
            "telephone_number": "719-557-5855",
            "fax_number": "719-557-4690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "902 LAKEVIEW AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810043597",
            "telephone_number": "719-557-5855",
            "fax_number": "719-557-4690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KIMBERLEY",
        "middle_name": "EVELYN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-22",
        "last_updated": "2011-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PA",
            "license": "OS014960",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PENNSYLVANIA OSTEOPATHIC MEDICAL BOARD",
            "identifier": "OS014960",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COLORADO LICENSE",
            "identifier": "50533",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jace'S Place Limited Liability Co.
• Carla Jean Jackson-Howard, ACNP-BC
• Brittany Oreon Jackson, MBA
• Jaelyn Davette Jackson
• John Mark Jackson
• Linda D Jackson, RN,MSN,NP-C
• Kandus Jacobs
• Susanna Jacobs, DPM
• Lisa Jagger, BSW
• William J. Jagger, D.D.S.

• General Practice Physician in Pueblo, CO
• Providers in Pueblo, CO by specialty
• General Practice Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2011; 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.