Active NPI
Michelle Maria Jackson, RN
- Health Educator
- Brooklyn, NY
National Provider Identifier
1184196685
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Health Educator
- Practice address
- 220 E 89TH St
Brooklyn, NY 11236-1418 - Phone
- (718) 690-5751
- NPI assigned
- Dec 20, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Educator | 174H00000X | Primary |
Addresses
Primary practice location
220 E 89TH St
Brooklyn, NY 11236-1418
Mailing address
220 E 89TH St
Brooklyn, NY 11236-1418
Phone (718) 690-5751
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 397531715 | Medicaid | NY |
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)
- Not enrolled
- Credentials
- Registered Nurse
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1545264000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1545264000000",
"number": "1184196685",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "220 E 89TH ST",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112361418",
"telephone_number": "718-690-5751"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "220 E 89TH ST",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112361418",
"telephone_number": "718-690-5751"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "MICHELLE",
"middle_name": "MARIA",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-12-20",
"last_updated": "2018-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "174H00000X",
"taxonomy_group": "",
"desc": "Health Educator",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "397531715",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.