Stephenie C Jackson, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

RN2288835 Issued in MA

Practice address

119 W Selden St
Mattapan, MA 02126-2348

Phone

(617) 407-7879

NPI assigned

Aug 6, 2021

Last updated

Mar 25, 2025By 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 3

Addresses

Other names 1

• Stephenie Jackson-Wilson Other name

Medicare fee-for-service enrollment

Enrolled in MA

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

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: sjacksonwilson367198@direct.ochin.org

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.

• Access Care Everywhere, LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Mattapan, MA
  • NPI 1699580647

  Multi-Specialty

  Medicare reassignment NPD

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

{
    "created_epoch": "1628208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742860800000",
    "number": "1427722917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 W SELDEN ST # 2",
            "city": "MATTAPAN",
            "state": "MA",
            "postal_code": "021262348",
            "telephone_number": "617-407-7879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 W SELDEN ST",
            "city": "MATTAPAN",
            "state": "MA",
            "postal_code": "021262348",
            "telephone_number": "617-407-7879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "STEPHENIE",
        "middle_name": "C",
        "credential": "PMHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-08-06",
        "last_updated": "2025-03-25",
        "certification_date": "2025-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MA",
            "license": "RN2288835",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MA",
            "license": "2118",
            "primary": false
        },
        {
            "code": "163WA0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Addiction (Substance Use Disorder)",
            "state": "MA",
            "license": "6873",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STEPHENIE",
            "last_name": "JACKSON-WILSON",
            "credential": "PMHNP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Courtney E Iftiger, DPT
• Promise Uchegbulam Igbokwe, CLINICIAN
• J&M Exceptional Care
• Michelle A Jack, RN
• Sharon Denise Jackson, MS RD CDE
• Catherine Susan Jacobs, LICSW
• Nancy Jean-Baptiste
• Ruth-Fiona Jeanty-Bazile
• Georgette Jeanty, M.D.
• Nyell Inga Jeudy I

• Psychiatric/Mental Health Nurse Practitioner in Mattapan, MA
• Providers in Mattapan, MA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2025; 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.