Active NPI
Dominique Terence Jackson, NURSE PRACTITIONER
- Family Nurse Practitioner
- Columbus, OH
National Provider Identifier
1174081822
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- APRN.CNP.024669
- Practice address
- 1791 Alum Creek Dr Ste 100
Columbus, OH 43207 - Phone
- (614) 526-5420
- Fax
- (614) 645-5517
- NPI assigned
- Mar 12, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | APRN.CNP.024669 | OH | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
1791 Alum Creek Dr Ste 100
Columbus, OH 43207
Mailing address
2780 Airport Dr Ste 100
Columbus, OH 43219-2289
Phone (614) 859-1906
Other practice location 1
1301 Atlantic Ave
Atlantic City, NJ 08401-7247
Phone (609) 572-0000
Other practice location 2
1 N White Horse Pike
Hammonton, NJ 08037-1875
Phone (609) 567-1169
Other practice location 3
1301 Atlantic Ave
Atlantic City, NJ 08401-7247
Phone (609) 572-0000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Practitioner
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1552348800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1565049600000",
"number": "1174081822",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2780 AIRPORT DR STE 100",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432192289",
"telephone_number": "614-859-1906",
"fax_number": "614-645-5517"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1791 ALUM CREEK DR STE 100",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "43207",
"telephone_number": "614-526-5420",
"fax_number": "614-645-5517"
}
],
"practiceLocations": [
{
"address_1": "1301 Atlantic Ave",
"address_purpose": "LOCATION",
"city": "Atlantic City",
"state": "NJ",
"postal_code": "084017247",
"country_code": "US",
"telephone_number": "609-572-0000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1 N White Horse Pike",
"address_purpose": "LOCATION",
"city": "Hammonton",
"state": "NJ",
"postal_code": "080371875",
"country_code": "US",
"telephone_number": "609-567-1169",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1301 Atlantic Ave",
"address_purpose": "LOCATION",
"city": "Atlantic City",
"state": "NJ",
"postal_code": "084017247",
"country_code": "US",
"telephone_number": "609-572-0000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JACKSON",
"first_name": "DOMINIQUE",
"middle_name": "TERENCE",
"credential": "NURSE PRACTITIONER",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-03-12",
"last_updated": "2019-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "OH",
"license": "APRN.CNP.024669",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbus, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.