Active NPI
Alice Louise Jackson, RN
- Registered Nurse
- Fort Gordon, GA
National Provider Identifier
1366838906
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- RN062766
- Practice address
- 300 Hospital Drive
Fort Gordon, Georgia
Fort Gordon, GA 30905 - Phone
- (706) 787-6692
- NPI assigned
- Apr 10, 2015
- Last updated
- May 26, 2015
- 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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN062766 | GA | Primary |
Addresses
Primary practice location
300 Hospital Drive
Fort Gordon, Georgia
Fort Gordon, GA 30905
Mailing address
300 Hospital Drive East
Fort Gordon, GA 30905
Phone (706) 787-6692
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
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN062766 | GA | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1428624000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1432598400000",
"number": "1366838906",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 HOSPITAL DRIVE EAST",
"city": "FORT GORDON",
"state": "GA",
"postal_code": "30905",
"telephone_number": "706-787-6692"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 HOSPITAL DRIVE",
"address_2": "FORT GORDON, GEORGIA",
"city": "FORT GORDON",
"state": "GA",
"postal_code": "30905",
"telephone_number": "706-787-6692"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "ALICE",
"middle_name": "LOUISE",
"name_prefix": "Mrs.",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-04-10",
"last_updated": "2015-05-26",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "GA",
"license": "RN062766",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Gordon, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.