Kimberly T Jackson, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

OS9724 Issued in FL

Practice address

2110 N Donnelly St
#200
Mount Dora, FL 32757-6966

Phone

(352) 735-8231

NPI assigned

Jul 26, 2006

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

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.

• Premise Health of Florida Medical PA

  • Multi-Specialty Clinic/Center
  • Mount Dora, FL
  • NPI 1386318434
  NPD (past)
• Sigma Medical Group, LLC

  • Family Medicine Physician
  • Orlando, FL
  • NPI 1831627579
  NPD (past)
• Winter Haven Hospital Inc

  • General Acute Care Hospital
  • Winter Haven, FL
  • NPI 1477599975
  NPD (past)

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454284800000",
    "number": "1346263449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2110 N DONNELLY ST",
            "address_2": "#200",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "327576966",
            "telephone_number": "352-735-8231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2110 N DONNELLY ST",
            "address_2": "#200",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "327576966",
            "telephone_number": "352-735-8231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KIMBERLY",
        "middle_name": "T",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-26",
        "last_updated": "2016-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS9724",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ivette Santiago M D P a
• J & G Florida Enterprises
• J&T Divine Care
• J&T Divine Care
• Jack L Cassell M.D. P.a.
• Jaime H Mejia MD PA
• Jaime Penix MD PA
• Janet L Black D P M P a
• Ashley Michelle Jass, CD(DONA)
• Marlyne Jean-Pierre, M.S.

• Family Medicine Physician in Mount Dora, FL
• Providers in Mount Dora, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.