Lastasha R Jackson, CRNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

SP022131 Issued in PA

Practice address

215 Bullens LN
Woodlyn, PA 19094-2001

Phone

(484) 416-0769

NPI assigned

Jun 30, 2021

Sex

Female

Sole proprietor

Yes

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 PA

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

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Avenues Recovery Medical Center at Valley ForgeGroup PAC ID 3678972130, 21 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Valley Forge Medical Center Hospital, Norristown, PA, CCN 390272

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Avenues Recovery Medical Center at Valley Forge

  • Addiction Medicine (Family Medicine) Physician
  • Norristown, PA
  • NPI 1326622069

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Pennsylvania Urgent Care Centers, PLLC

  • Urgent Care Clinic/Center
  • Downingtown, PA
  • NPI 1902128721

  Single Specialty

  Medicare reassignment NPD
• Gentle Force Counseling Services

  • Substance Use Disorder Rehabilitation Hospital Unit
  • Jenkintown, PA
  • NPI 1073128690
  Medicare reassignment
• Avenues Recovery Medical Center at Valley Forge

  • General Acute Care Hospital
  • Norristown, PA
  • NPI 1407430291
  NPD
• MHP MD PLLC

  • Urgent Care Clinic/Center
  • Conshohocken, PA
  • NPI 1508538695

  Single Specialty

  NPD
• Hosana Home Health Care Services, LLC

  • Home Health Agency
  • Woodlyn, PA
  • NPI 1780058602
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Avenues Recovery Medical Center at Valley Forge

  • General Acute Care Hospital
  • Norristown, PA
  • NPI 1407430291
  Care Compare affiliation

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

{
    "created_epoch": "1625011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625011200000",
    "number": "1356911325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 E BROWN ST",
            "city": "NORRISTOWN",
            "state": "PA",
            "postal_code": "194015407",
            "telephone_number": "484-213-3591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 BULLENS LN",
            "city": "WOODLYN",
            "state": "PA",
            "postal_code": "190942001",
            "telephone_number": "484-416-0769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "LASTASHA",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "CRNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-06-30",
        "last_updated": "2021-06-30",
        "certification_date": "2021-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP022131",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• George L. Rodriguez, M.D., P.C.
• George L. Rodriguez, M.D., P.C.
• Bruce H. Godick, D.M.D.
• Laura Heberley, RN, M.S., ATC
• Hosana Home Health Care Services, LLC
• Randall King, PHARMD
• Kenneth Korab
• Sarayoobala Krishnan
• Devin M Layton, ED.D
• Pramod S Lele, MD

• Family Nurse Practitioner in Woodlyn, PA
• Providers in Woodlyn, PA by specialty
• Family Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.