Active NPI
Terry Lynn Jackson, DNP, ACNPC-AG
- Acute Care Nurse Practitioner
- Shreveport, LA
National Provider Identifier
1366056871
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acute Care Nurse Practitioner
- License
- 200793
- Practice address
- 2551 Greenwood Rd Ste 210
Shreveport, LA 71103-3985 - Phone
- (318) 635-0834
- Fax
- (318) 212-3958
- NPI assigned
- Sep 2, 2020
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Acute Care Nurse Practitioner | 363LA2100X | 200793 | LA | Primary |
Addresses
Primary practice location
2551 Greenwood Rd Ste 210
Shreveport, LA 71103-3985
Mailing address
2551 Greenwood Rd Ste 210
Shreveport, LA 71103-3985
Phone (318) 635-0834
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://www.mettles.com/ | Other | |
| CONNECT URL | //www.mettles.com/ | Other |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 200793 | LA | MD | Acute Care Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1599004800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623801600000",
"number": "1366056871",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2551 GREENWOOD RD STE 210",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711033985",
"telephone_number": "318-635-0834",
"fax_number": "318-212-3958"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2551 GREENWOOD RD STE 210",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711033985",
"telephone_number": "318-635-0834",
"fax_number": "318-212-3958"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "TERRY",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "DNP, ACNPC-AG",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-09-02",
"last_updated": "2021-06-16",
"certification_date": "2021-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2100X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Acute Care",
"state": "LA",
"license": "200793",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "https://www.mettles.com/",
"affiliation": "N",
"endpointDescription": "2.16.840.1.113883.3.6037.1",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "CMS esMD eMDR",
"address_1": "10320 Little Patuxent Pkwy Ste 233-02",
"city": "Columbia",
"state": "MD",
"country_code": "US",
"postal_code": "210443313",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "//www.mettles.com/",
"affiliation": "N",
"endpointDescription": "2.16.840.1.113883.3.6037.1",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "CMS esMD eMDR",
"address_1": "10320 Little Patuxent Pkwy Ste 233-02",
"city": "Columbia",
"state": "MD",
"country_code": "US",
"postal_code": "210443313",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Shreveport, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.