Kelly Ann Jackson, AGNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

26NJ15451800 Issued in NJ

Practice address

8 Scudder Rd
Ewing, NJ 08628-2309

Phone

(609) 586-6678

NPI assigned

Oct 30, 2025

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fair Medical Services LLC

  • Family Medicine Physician
  • Hamilton, NJ
  • NPI 1578914933
  NPD (past)

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

{
    "created_epoch": "1761782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763942400000",
    "number": "1174492185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 SCUDDER RD",
            "city": "EWING",
            "state": "NJ",
            "postal_code": "086282309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8 SCUDDER RD",
            "city": "EWING",
            "state": "NJ",
            "postal_code": "086282309",
            "telephone_number": "609-586-6678"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4 Princess Rd Ste 206",
            "address_purpose": "LOCATION",
            "city": "Lawrenceville",
            "state": "NJ",
            "postal_code": "086482322",
            "country_code": "US",
            "telephone_number": "609-482-3701",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KELLY",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "AGNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-10-30",
        "last_updated": "2025-11-24",
        "certification_date": "2025-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NJ",
            "license": "26NJ15451800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Infocus Urgent Care Campus Town, LLC
• Instride Health NJ PC
• Ivee Medical PC
• J M Podiatry Associates PC
• J M Podiatry Associates PC
• Monique Rochell Jackson, RN
• Jamiera Jacobs
• Scott Jaffe, D.C., RPH.
• Aarti Sunder Jagtiani
• Aminata Jalloh, LPN

• Nurse Practitioner in Ewing, NJ
• Providers in Ewing, NJ by specialty
• Nurse Practitioner in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2025; 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.