Individual provider Active NPI

Jo E Jackson, FNP

  • Family Nurse Practitioner
  • Carlisle, KY
National Provider Identifier
1336812569
Registry record updated Mar 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
3016232 Issued in KY
Practice address
160 Bakers Acre Rd
Carlisle, KY 40311-9421
Phone
(859) 473-0271
NPI assigned
Jul 25, 2021
Last updated
Mar 31, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 3016232 KY Primary

Addresses

Primary practice location

160 Bakers Acre Rd
Carlisle, KY 40311-9421

Mailing address

450A Tucker Dr
Maysville, KY 41056-9110
Phone (606) 759-0339

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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

Enrollment IDStateProvider typePAC IDDetails
I20210901002738 KY Practitioner - Nurse Practitioner 4981000858 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3016232KYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Harrison Memorial Hospital Family CurrentSince Aug 1, 2022 Accepting new patients
Harrison Memorial Hospital CurrentSince Aug 1, 2022 Accepting new patients
Signify Health, LLC CurrentSince Nov 15, 2024 Accepting new patients
St Elizabeth Medical Center, Inc PastSince Aug 1, 2021 Accepting new patients

Locations

1210 KY Highway 36 E
Cynthiana, KY 41031
Phone (859) 234-2300

1210 KY Highway 36 E
Ste G3
Cynthiana, KY 41031
Phone (859) 234-9222

439 E Pleasant St
Cynthiana, KY 41031
Phone (859) 234-4494

312 S 4th St
Ste 700
Louisville, KY 40202
Phone (502) 628-5023

4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1627171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648684800000",
    "number": "1336812569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450A TUCKER DR",
            "city": "MAYSVILLE",
            "state": "KY",
            "postal_code": "410569110",
            "telephone_number": "606-759-0339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 BAKERS ACRE RD",
            "city": "CARLISLE",
            "state": "KY",
            "postal_code": "403119421",
            "telephone_number": "859-473-0271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JO",
        "middle_name": "E",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-25",
        "last_updated": "2022-03-31",
        "certification_date": "2022-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3016232",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carlisle, KY

Sources for this page

Verify at the official NPI Registry.