Active NPI
Nancy Cheri Jackson, NURSE PRACTITIONER
- Registered Nurse
- Spring Valley, CA
National Provider Identifier
1336802412
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 714784
- Practice address
- 9735 Campo Rd Ste 270
Spring Valley, CA 91977-1490 - Phone
- (619) 465-4982
- NPI assigned
- Oct 15, 2021
- 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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 714784 | CA | Primary |
Addresses
Primary practice location
9735 Campo Rd Ste 270
Spring Valley, CA 91977-1490
Mailing address
9735 Campo Rd Ste 270
Spring Valley, CA 91977-1490
Phone (619) 465-4982
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 714784 | CA | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1634256000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694736000000",
"number": "1336802412",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9735 CAMPO RD STE 270",
"city": "SPRING VALLEY",
"state": "CA",
"postal_code": "919771490",
"telephone_number": "619-465-4982"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9735 CAMPO RD STE 270",
"city": "SPRING VALLEY",
"state": "CA",
"postal_code": "919771490",
"telephone_number": "619-465-4982"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "NANCY",
"middle_name": "CHERI",
"credential": "NURSE PRACTITIONER",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-10-15",
"last_updated": "2023-09-15",
"certification_date": "2023-09-14",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "CA",
"license": "714784",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Spring Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2023; 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.