Nicole Jackson, FNP, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

L80010226 Issued in DE

Practice address

200 Banning St Ste 260
Dover, DE 19904-3489

Phone

(302) 224-1400

Fax

(302) 224-1402

NPI assigned

Mar 28, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in DE

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, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

A Peaceful Place Integrated CareGroup PAC ID 1355742735, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: peacefulplace.nicolejackson@149154.advancedmd-direct.com

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.

• A Peaceful Place Integrated Care

  • Family Nurse Practitioner
  • Dover, DE
  • NPI 1801487046
  Medicare reassignment Care Compare group NPD
• Genesis Integrative Mental Health

  • Psychiatric/Mental Health Nurse Practitioner
  • Dover, DE
  • NPI 1598534711
  Medicare reassignment NPD Authorized official
• Anew Mental Health

  • Mental Health Counselor
  • Dover, DE
  • NPI 1780092528
  Medicare reassignment NPD
• Mid-Atlantic Behavioral Health, LLC

  • Intellectual & Developmental Disabilities Psychologist
  • Newark, DE
  • NPI 1871719872
  Medicare reassignment NPD
• Westside Family Healthcare, Inc.

  • Federally Qualified Health Center (FQHC)
  • Wilmington, DE
  • NPI 1952303695
  Medicare reassignment NPD

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

{
    "created_epoch": "1490659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676851200000",
    "number": "1366974628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 BANNING ST STE 260",
            "city": "DOVER",
            "state": "DE",
            "postal_code": "199043489",
            "telephone_number": "302-224-1400",
            "fax_number": "302-224-1402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 BANNING ST STE 260",
            "city": "DOVER",
            "state": "DE",
            "postal_code": "199043489",
            "telephone_number": "302-224-1400",
            "fax_number": "302-224-1402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "NICOLE",
        "credential": "FNP, PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-28",
        "last_updated": "2023-02-20",
        "certification_date": "2023-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "DE",
            "license": "LG0001029",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "DE",
            "license": "LG0001029",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "DE",
            "license": "L80010226",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hamza Samir Jaber, MD
• Jack R. Milligan M.D., P.a.
• Chenitra Jack
• Jeffrey I Jackerson, D.O.
• Ebony Adele Jackson, CRNP
• Tyra Jackson
• Susan Lynn Jacobs, BCBA
• Amber Rose Jacobson
• Rakesh Jaitly, MD
• Mashonda James

• Psychiatric/Mental Health Nurse Practitioner in Dover, DE
• Providers in Dover, DE by specialty
• Psychiatric/Mental Health Nurse Practitioner in Delaware

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2023; 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.