Active NPI
Deborah Jackson, CRNP
- Adult Health Nurse Practitioner
- Columbia, MD
National Provider Identifier
1356436273
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- R048240
- Practice address
- 8875 Centre Park Dr
Suite D
Columbia, MD 21045-2114 - Phone
- (410) 730-1000
- Fax
- (410) 730-8615
- NPI assigned
- Oct 4, 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 |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | R048240 | MD | Primary |
Addresses
Primary practice location
8875 Centre Park Dr
Suite D
Columbia, MD 21045-2114
Mailing address
8875 Centre Park Dr
Suite D
Columbia, MD 21045-2114
Phone (410) 730-1000
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 63697401 | Other | MD | BLUE SHIELD |
| C4280003 | Other | DC | BLUE SHIELD |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R048240 | MD | MD | Adult Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1228089600000",
"number": "1356436273",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8875 CENTRE PARK DR",
"address_2": "SUITE D",
"city": "COLUMBIA",
"state": "MD",
"postal_code": "210452114",
"telephone_number": "410-730-1000",
"fax_number": "410-730-8615"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8875 CENTRE PARK DR",
"address_2": "SUITE D",
"city": "COLUMBIA",
"state": "MD",
"postal_code": "210452114",
"telephone_number": "410-730-1000",
"fax_number": "410-730-8615"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "DEBORAH",
"credential": "CRNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-04",
"last_updated": "2008-12-01",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "MD",
"license": "R048240",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "63697401",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "C4280003",
"state": "DC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Columbia, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.