Active NPI
Alice Jackson, RN NP
- Nurse Practitioner
- Fresno, CA
National Provider Identifier
1295754109
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 358153
- Practice address
- 6121 N Thesta
Suite 303
Fresno, CA 93710-5294 - Phone
- (559) 228-5448
- Fax
- (559) 224-3920
- NPI assigned
- Jul 19, 2006
- 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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 358153 | CA | Primary |
Addresses
Primary practice location
6121 N Thesta
Suite 303
Fresno, CA 93710-5294
Mailing address
PO Box 28947
Fresno, CA 93729-8947
Phone (559) 228-5448
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)
- Enrolled
- Credentials
- Nurse Practitioner, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 358153 | CA | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1197590400000",
"number": "1295754109",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 28947",
"city": "FRESNO",
"state": "CA",
"postal_code": "937298947",
"telephone_number": "559-228-5448",
"fax_number": "559-224-3920"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6121 N THESTA",
"address_2": "SUITE 303",
"city": "FRESNO",
"state": "CA",
"postal_code": "937105294",
"telephone_number": "559-228-5448",
"fax_number": "559-224-3920"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "ALICE",
"credential": "RN NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-19",
"last_updated": "2007-12-14",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "CA",
"license": "358153",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fresno, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.