Sandra F Jackson, CRNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

SP008227 Issued in PA

Practice address

23 W 37TH St
Wilmington, DE 19802-2225

Phone

(302) 450-4551

Fax

(302) 355-2550

NPI assigned

Feb 3, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1138924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592870400000",
    "number": "1396717286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23 W 37TH ST",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198022225",
            "telephone_number": "302-450-4551",
            "fax_number": "302-355-2550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 W 37TH ST",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198022225",
            "telephone_number": "302-450-4551",
            "fax_number": "302-355-2550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SANDRA",
        "middle_name": "F",
        "name_prefix": "Ms.",
        "credential": "CRNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-02-03",
        "last_updated": "2020-06-23",
        "certification_date": "2020-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "DE",
            "license": "LG-0000519",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "SP008227",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1396717286 363L00000",
            "state": "DE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimberly Jackson
• Kimberly Jackson, LPCMH
• Kyle Jackson, DO
• Leslie K Jackson, CRNA
• Randy Eugene Jackson Jr., PHARMD
• Satyre Jackson
• Shawnell Jackson, LPN
• Tracey Jackson
• Willie Lee Jackson III
• Bobbi Ann Jacobs-Hoover, LMSW, CADC

• Nurse Practitioner in Wilmington, DE
• Providers in Wilmington, DE by specialty
• Nurse Practitioner in Delaware

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2020; 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.