Active NPI
Jacquelyn Marie Jackson
- Nurse's Aide
- Mt Pleasant, SC
National Provider Identifier
1366627002
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse's Aide
- License
- 120514E
- Practice address
- 1609 Hiway 41
Mt Pleasant, SC 29464 - Phone
- (843) 870-1839
- NPI assigned
- Dec 31, 2007
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Aide | 374U00000X | 120514E | ||
| Homemaker | 376J00000X | |||
| Nurse's Aide | 376K00000X | 120514E | Primary |
Addresses
Primary practice location
1609 Hiway 41
Mt Pleasant, SC 29464
Mailing address
PO Box 2522
Mt Pleasant, SC 29464
Phone (843) 870-1839
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1199059200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1199059200000",
"number": "1366627002",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2522",
"city": "MT PLEASANT",
"state": "SC",
"postal_code": "29464",
"telephone_number": "843-870-1839"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1609 HIWAY 41",
"city": "MT PLEASANT",
"state": "SC",
"postal_code": "29464",
"telephone_number": "843-870-1839"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "JACQUELYN",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-12-31",
"last_updated": "2007-12-31",
"status": "A"
},
"taxonomies": [
{
"code": "374U00000X",
"taxonomy_group": "",
"desc": "Home Health Aide",
"state": null,
"license": "120514E",
"primary": false
},
{
"code": "376J00000X",
"taxonomy_group": "",
"desc": "Homemaker",
"state": null,
"license": null,
"primary": false
},
{
"code": "376K00000X",
"taxonomy_group": "",
"desc": "Nurse's Aide",
"state": null,
"license": "120514E",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mt Pleasant, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.