Jacquelynne Jackson, RN, BSN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

2000158981 Issued in MO

Practice address

1 Jefferson Barracks Dr
Saint Louis, MO 63125-4181

Phone

(314) 894-6654

Fax

(314) 894-5775

NPI assigned

Jan 16, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Jackie Jackson Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor on Science - Nursing, Registered Nurse

State licenses

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

{
    "created_epoch": "1705363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706659200000",
    "number": "1386415578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 RED FOX RD",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622232242",
            "telephone_number": "618-444-5071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 JEFFERSON BARRACKS DR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631254181",
            "telephone_number": "314-894-6654",
            "fax_number": "314-894-5775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JACQUELYNNE",
        "credential": "RN, BSN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-16",
        "last_updated": "2024-01-31",
        "certification_date": "2024-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MO",
            "license": "2000158981",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACKIE",
            "last_name": "JACKSON",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Francine Jackson, ANP-BC
• Gina Lynn Jackson, LCSW
• Harold Gerard Jackson II, M.D.
• Holly Alegro Jackson
• Jacqueline Jackson
• Karin Rochelle Jackson
• Karissa Jackson
• Kathryn Jackson, MSW, LCSW
• Kathryn E. Jackson, D.O.
• Kathryn M Jackson, RDN

• Registered Nurse in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Registered Nurse in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.