Cynthia Jackson, PSYCH NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

990052 Issued in CO

Practice address

6093 S Quebec St Ste 100
Centennial, CO 80111-4543

Phone

(303) 770-6933

NPI assigned

Oct 4, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Apr 1, 2019 through Apr 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626825600000",
    "number": "1215022280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6093 S QUEBEC ST STE 100",
            "city": "CENTENNIAL",
            "state": "CO",
            "postal_code": "801114543",
            "telephone_number": "303-770-6933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6093 S QUEBEC ST STE 100",
            "city": "CENTENNIAL",
            "state": "CO",
            "postal_code": "801114543",
            "telephone_number": "303-770-6933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CYNTHIA",
        "credential": "PSYCH NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-04",
        "last_updated": "2021-07-21",
        "certification_date": "2021-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC1500X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Community Health",
            "state": "CO",
            "license": "176692",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CO",
            "license": "990052",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "71671218",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• J Jay Lee M D LLC
• J.C. Kolhouse Counseling PLLC
• Jacey J. Yunker, LCSW, Counseling, LLC
• Lauran Jacks, LCSW, PSYD.
• Dominique Jackson-Coy, LSW
• Keli Nalu Patricia Jackson, PA-C
• Erin Colleen Jacob, PA-C
• Laura L Jacob, RDH
• Donald Richard Jacobs, MD
• Murray Jacobs, D.D.S.

• Psychiatric/Mental Health Nurse Practitioner in Centennial, CO
• Providers in Centennial, CO by specialty
• Psychiatric/Mental Health Nurse Practitioner in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2021; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.