Jennifer Joy Jacklin, CPNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

152024 Issued in MO

Practice address

10777 Sunset Office Dr Ste 110
Saint Louis, MO 63127-1019

Phone

(314) 781-7415

Fax

(314) 644-4592

NPI assigned

Apr 17, 2007

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

Enrolled in MO

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

Certified Pediatric Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jjacklin1079@directc.mercy.net

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.

• Mercy Clinic East Communities

  • Internal Medicine Physician
  • Saint Louis, MO
  • NPI 1851335228
  NPD (past)

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548806400000",
    "number": "1326264441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 HOLLYBEND DR",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630216537",
            "telephone_number": "314-276-1428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10777 SUNSET OFFICE DR STE 110",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631271019",
            "telephone_number": "314-781-7415",
            "fax_number": "314-644-4592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKLIN",
        "first_name": "JENNIFER",
        "middle_name": "JOY",
        "credential": "CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-17",
        "last_updated": "2019-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MO",
            "license": "152024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alivia Jachimiak, STUDENT
• Carolyn M Jachna, MD
• Jack L. Croughan Inc
• Jack M. Marincel, D.D.S., P.C.
• Jack W. Haney, D.D.S., P.C. (Forest Park Dental)
• Briana Jackowski, PA-C
• Rosa J Jacks-Loya, LPC
• Roberta Jackson-Babel, MA, PLPC
• Erika Jackson-Essiem
• Brandy Jackson

• Pediatric Nurse Practitioner in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Pediatric Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2019; 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.