Emma J Jackson, NP

Primary specialty

Pediatric Registered NurseTaxonomy code 163WP0200X

License

95042368 Issued in CA

Practice address

33048 Canopy LN
Lake Elsinore, CA 92532-2535

Phone

(909) 614-3039

NPI assigned

Nov 6, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

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  Medicare reassignment NPD

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

{
    "created_epoch": "1541462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596758400000",
    "number": "1255809372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33048 CANOPY LN",
            "city": "LAKE ELSINORE",
            "state": "CA",
            "postal_code": "925322535",
            "telephone_number": "909-614-3039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33048 CANOPY LN",
            "city": "LAKE ELSINORE",
            "state": "CA",
            "postal_code": "925322535",
            "telephone_number": "909-614-3039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "EMMA",
        "middle_name": "J",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-11-06",
        "last_updated": "2020-08-07",
        "certification_date": "2020-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "RN95042368",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "NP950147",
            "primary": false
        },
        {
            "code": "163WP0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Pediatrics",
            "state": "CA",
            "license": "95042368",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Integral Companies, LLC
• Intuition Speech Therapy, Inc.
• Natalia Kearney Isaacs
• Maureen Nwaobilor Iwuoha, NP
• J M Asprec MD
• Raquel Jackson
• Ryan Jacobs, PA-C
• Eyvonne Jacskon, LVN
• Jana Tran D.D.S. Inc.
• Allen Jimenez

• Pediatric Registered Nurse in Lake Elsinore, CA
• Providers in Lake Elsinore, CA by specialty
• Pediatric Registered Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.