Kristen Elizabeth Jackson, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

0024185074 Issued in VA

Practice address

2418 Fletchers Ridge Rd
Vansant, VA 24656-7554

Phone

(276) 701-1390

NPI assigned

Oct 18, 2022

Last updated

Oct 18, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/19847/brand/3/csg/21/fhir/r4
• Direct secure messaging: kristen.jackson.1@19847.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Clinch Valley Physicians Associates LLC

  dba Clinch Valley Physicians

  • Cardiovascular Disease Physician
  • Richlands, VA
  • NPI 1104265214
  Medicare reassignment NPD
• Clinch Valley Physicians Associates LLC

  dba Clinch Valley Physicians

  • Rural Health Clinic/Center
  • Cedar Bluff, VA
  • NPI 1821339540
  NPD
• Clinch Valley Physicians Inc

  • Clinical Medical Laboratory
  • Richlands, VA
  • NPI 1669454781
  NPD (past)

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

{
    "created_epoch": "1666051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666051200000",
    "number": "1396461745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2418 FLETCHERS RIDGE RD",
            "city": "VANSANT",
            "state": "VA",
            "postal_code": "246567554",
            "telephone_number": "276-701-1390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2418 FLETCHERS RIDGE RD",
            "city": "VANSANT",
            "state": "VA",
            "postal_code": "246567554",
            "telephone_number": "276-701-1390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KRISTEN",
        "middle_name": "ELIZABETH",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-10-18",
        "last_updated": "2022-10-18",
        "certification_date": "2022-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024185074",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy R Cook, OTR/L
• Aimee Gibbs
• Hand in Hand, PLLC
• Kathryn Dellinger Hannah, LPC
• Melissa Kay Horne, CMT
• K-VA-T Food Stores, Inc. (Food City Pharmacy #839)
• Kathryn Keene, COTA/L
• Tiffany Keene, COTA/L
• Marian Annette Looney, OTR/L
• Angelia McClanahan, LCSW

• Family Nurse Practitioner in Vansant, VA
• Providers in Vansant, VA by specialty
• Family Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.