Olga R Jackson, FNP-BC, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

2021038727 Issued in CA

Practice address

25819 Jefferson Ave Ste 110
Murrieta, CA 92562-6965

Phone

(909) 360-3738

NPI assigned

Feb 8, 2019

Last updated

Mar 8, 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 2

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Duality Mental Health Nursing Services

  • Psychiatric/Mental Health Nurse Practitioner
  • Murrieta, CA
  • NPI 1821860511
  NPD Authorized official
• Christian R Small MD a Professional Corporation

  dba Headlands Addiction Treatment Services

  • Multi-Specialty Clinic/Center
  • Escondido, CA
  • NPI 1285213132
  NPD (past)

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

{
    "created_epoch": "1549584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646697600000",
    "number": "1205391703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38596 FAIRFIELD HTS",
            "city": "MURRIETA",
            "state": "CA",
            "postal_code": "925630314",
            "telephone_number": "213-842-7242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25819 JEFFERSON AVE STE 110",
            "city": "MURRIETA",
            "state": "CA",
            "postal_code": "925626965",
            "telephone_number": "909-360-3738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "OLGA",
        "middle_name": "R",
        "name_prefix": "Mrs.",
        "credential": "FNP-BC, PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-08",
        "last_updated": "2022-03-08",
        "certification_date": "2022-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95011026",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "2021038727",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Danielle Jack
• Jackson and Lee Dental Corporation (Plaza Dental Group)
• Antoinette S Jackson-Sekunda, NP
• Amari Jackson
• Lester Jackson
• Renae Jackson
• Seana Alyssa Jackson
• Tatianna D Jackson
• William W Jackson, M.D.
• Natalie Jacobo

• Psychiatric/Mental Health Nurse Practitioner in Murrieta, CA
• Providers in Murrieta, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2022; 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.