Active NPI
Kimberly Chenault Jackson
- Nurse Practitioner
- Millbrook, AL
National Provider Identifier
1407796774
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 1-170200
- Practice address
- 222 Fairway Dr
Millbrook, AL 36054-1846 - Phone
- (334) 322-4886
- NPI assigned
- Mar 30, 2026
- 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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 1-170200 | AL | Primary |
Addresses
Primary practice location
222 Fairway Dr
Millbrook, AL 36054-1846
Mailing address
222 Fairway Dr
Millbrook, AL 36054-1846
Phone (334) 322-4886
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1-170200 | AL | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1774828800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1774828800000",
"number": "1407796774",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "222 FAIRWAY DR",
"city": "MILLBROOK",
"state": "AL",
"postal_code": "360541846",
"telephone_number": "334-322-4886"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "222 FAIRWAY DR",
"city": "MILLBROOK",
"state": "AL",
"postal_code": "360541846",
"telephone_number": "334-322-4886"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "KIMBERLY",
"middle_name": "CHENAULT",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-03-30",
"last_updated": "2026-03-30",
"certification_date": "2026-03-29",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "AL",
"license": "1-170200",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Millbrook, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.