Carol Diane Jackson, ARNP
Individual provider Active NPI Family Nurse Practitioner · Lansing, KS
NPI 1467420083 · NPPES record last updated Mar 24, 2016
Key facts
- NPI
- 1467420083
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 53-45399-121 (KS)
- Practice address
- 712 First Terrace
#200
Lansing, KS 66043-1735 - Phone
- (913) 727-6000
- Fax
- (913) 351-1346
- NPI assigned
- Mar 9, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 53-45399-121 | KS | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prime Healthcare Physician Services - Providence Inc | Past | Accepting new patients | |
| Providence Care Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 53-45399-121 | KS | Yes |
Addresses
Primary practice location
712 First Terrace
#200
Lansing, KS 66043-1735
Mailing address
8929 Parallel Parkway
PMG-Physician Credentialing Attn Kathleen
Kansas City, KS 66112-1689
Phone (913) 596-3893
Other providers in Lansing, KS
- Erin Katie Idacavage
- Integrity Neurosurgery, LLC
- Interventional Pain Group PA
- Emma Ivers
- Brenda Lee Jackson
- David A Jackson
- George F. Jackson Jr.
- Cara Breanne Jay
- Linda Kay Jensen
- Joel D Foster DPM PC
All providers in Lansing, KS · Family Nurse Practitioner in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 24, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.