Beulah Jackson, PHLEBOTOMIST

Primary specialty

Phlebotomy TechnicianTaxonomy code 246RP1900X

Practice address

603 Peters St
Wildwood, FL 34785-3927

Phone

(352) 292-6433

NPI assigned

Dec 14, 2021

Last updated

Dec 14, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1639440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639440000000",
    "number": "1225797566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1362",
            "city": "WILDWOOD",
            "state": "FL",
            "postal_code": "347851362",
            "telephone_number": "352-292-6433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 PETERS ST",
            "city": "WILDWOOD",
            "state": "FL",
            "postal_code": "347853927",
            "telephone_number": "352-292-6433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "BEULAH",
        "credential": "PHLEBOTOMIST",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-12-14",
        "last_updated": "2021-12-14",
        "certification_date": "2021-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246RP1900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician, Pathology, Phlebotomy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "Wildwood",
            "affiliation": "N",
            "endpointDescription": "beulahjackson39@gmail.com",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "useOtherDescription": "Wildwood",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Wildwood",
            "address_1": "603 Peters St",
            "city": "Wildwood",
            "state": "FL",
            "country_code": "US",
            "postal_code": "347853927",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Phlebotomy Technician in Wildwood, FL
• Providers in Wildwood, FL by specialty
• Phlebotomy Technician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2021; 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.