Active NPI
Debra Jackson, LPN
- Licensed Practical Nurse
- Brooklyn, NY
National Provider Identifier
1295033322
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 236779 9
- Practice address
- 1625 E 54TH St
Brooklyn, NY 11234-3919 - Phone
- (718) 915-0351
- NPI assigned
- Mar 14, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 236779 9 | NY | Primary |
Addresses
Primary practice location
1625 E 54TH St
Brooklyn, NY 11234-3919
Mailing address
1625 E 54TH St
Brooklyn, NY 11234-3919
Phone (718) 915-0351
Other names 1
- Prof. Debra Loretta Jackson
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 236779 9 | NY | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1300060800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1300147200000",
"number": "1295033322",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1625 E 54TH ST",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112343919",
"telephone_number": "718-915-0351"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1625 E 54TH ST",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112343919",
"telephone_number": "718-915-0351"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "DEBRA",
"name_prefix": "Prof.",
"credential": "LPN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-03-14",
"last_updated": "2011-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "NY",
"license": "236779 9",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "DEBRA",
"last_name": "JACKSON",
"middle_name": "LORETTA",
"prefix": "PROF.",
"credential": "LPN",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.