Kirstie Brooke Jackson

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

48357 Issued in SC

Practice address

41 Park Creek Dr
Greenville, SC 29605-4270

Phone

(864) 299-1600

NPI assigned

Jul 31, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Columbia Vamc

  • Department of Veterans Affairs (VA) Pharmacy
  • Greenville, SC
  • NPI 1265490155
  NPD

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

{
    "created_epoch": "1564531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564531200000",
    "number": "1265086953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "258 QUAIL RD",
            "city": "GRAY COURT",
            "state": "SC",
            "postal_code": "296454253",
            "telephone_number": "864-640-3837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41 PARK CREEK DR",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054270",
            "telephone_number": "864-299-1600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KIRSTIE",
        "middle_name": "BROOKE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-31",
        "last_updated": "2019-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "SC",
            "license": "48357",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hannah J Jackson
• Joanna Jackson
• Karen Mehlman Jackson, PHARMD
• Kathleen Marie Jackson, MD
• Kathryn Miles Jackson, AUD
• Kristen Staples Jackson, MCD
• Lauren Elizabeth Jackson, M.S., CCC-SLP
• Mark R Jackson, MD
• Marylee Jackson, PA
• Michelle Antonia Jackson

• Licensed Practical Nurse in Greenville, SC
• Providers in Greenville, SC by specialty
• Licensed Practical Nurse in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2019; 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.