Stephanie Kay Jackson

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

APRN11011834 Issued in FL

Practice address

199 Avenue B NW
Winter Haven, FL 33881-4546

Phone

(863) 293-1191

Fax

(863) 401-8058

NPI assigned

Dec 29, 2020

Last updated

Aug 5, 2022By 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 3

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: stephanie.jackson.p1@direct.bondclinicpa.nextgenshare.com

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.

• Bond Clinic PA

  • Internal Medicine Physician
  • Winter Haven, FL
  • NPI 1881639193
  Medicare reassignment NPD
• Lakeland Regional Health Systems, Inc.

  • Multi-Specialty Clinic/Center
  • Lakeland, FL
  • NPI 1497748743
  Medicare reassignment NPD
• Bond Clinic PA

  • Internal Medicine Physician
  • Winter Haven, FL
  • NPI 1992565766
  NPD
• Bond Urgent Care LLC

  • Urgent Care Clinic/Center
  • Winter Haven, FL
  • NPI 1235641739
  NPD (past)

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

{
    "created_epoch": "1609200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659657600000",
    "number": "1164019774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 E CENTRAL AVE",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338803094",
            "telephone_number": "863-293-1191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "199 AVENUE B NW",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338814546",
            "telephone_number": "863-293-1191",
            "fax_number": "863-401-8058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "STEPHANIE",
        "middle_name": "KAY",
        "name_prefix": "Miss",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-29",
        "last_updated": "2022-08-05",
        "certification_date": "2022-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "FL",
            "license": "APRN11011834",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "APRN11011834",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "FL",
            "license": "RN9260330",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jackson Diagnostic Imaging, Inc
• Daniel Jackson, COTA
• Jillian J Jackson, LCSW
• Patrice Jackson
• Sarelyn Bertina Jackson
• Jared Jacobs, APRN
• Maria Jaimes-Cid
• James a Truitt DMD PA
• James J Booker IV MD PA
• Calprunia James, APRN

• Family Nurse Practitioner in Winter Haven, FL
• Providers in Winter Haven, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.