Alice Marie Jackson, APN

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

APN0000015967 Issued in TN

Practice address

2690 Madison St
Suite 130
Clarksville, TN 37043-5975

Phone

(931) 245-1701

Fax

(931) 245-1720

NPI assigned

Aug 4, 2011

Last updated

Nov 4, 2014By 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 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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

• Gateway Medical Associates, P.C.

  • Internal Medicine Physician
  • Clarksville, TN
  • NPI 1780709451
  NPD

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

{
    "created_epoch": "1312416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415059200000",
    "number": "1285913566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2690 MADISON ST",
            "address_2": "SUITE 130",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370435975",
            "telephone_number": "931-245-1701",
            "fax_number": "931-245-1720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2690 MADISON ST",
            "address_2": "SUITE 130",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370435975",
            "telephone_number": "931-245-1701",
            "fax_number": "931-245-1720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ALICE",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-04",
        "last_updated": "2014-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TN",
            "license": "APN0000015967",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Ivy, SLPA
• J and J Medical Transport
• J and J Transportation
• J L Matheny Solutions, LLC
• Alex Mitchell Jackson, O.D.
• Alyssa Jackson, OD
• Azia Jackson, LPC-MHSP
• Chantella Jackson
• Deirdre Renee' Jackson, PHD LCMHCS LPC NCC
• Gale Evans Jackson, M.D.

• Nurse Practitioner in Clarksville, TN
• Providers in Clarksville, TN by specialty
• Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2014; 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.