Skin Wellness Dermatology Associates, PA

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

2013-00616 Issued in NC

Legal business name

SKIN WELLNESS DERMATOLOGY ASSOCIATES, PA

Practice address

245 East NC Highway 54
Ste 202
Durham, NC 27713-2150

Phone

(919) 294-9440

Fax

(919) 237-3899

NPI assigned

Jun 1, 2015

Last updated

Mar 25, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Brooke A Jackson, M.D.NPI 1093887960

Title

President-Owner

Phone

(919) 294-9440

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/13216/brand/1/csg/1/fhir/r4

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Brooke A Jackson, MD

  • Dermatology Physician
  • Durham, NC
  • NPI 1093887960
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1433116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458864000000",
    "number": "1467832881",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 EAST NC HWY 54",
            "address_2": "SUITE 202",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277132150",
            "telephone_number": "919-294-9440",
            "fax_number": "919-237-3899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 EAST NC HIGHWAY 54",
            "address_2": "STE 202",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277132150",
            "telephone_number": "919-294-9440",
            "fax_number": "919-237-3899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SKIN WELLNESS DERMATOLOGY ASSOCIATES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-01",
        "last_updated": "2016-03-25",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "BROOKE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT-OWNER",
        "authorized_official_telephone_number": "919-294-9440",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "NC",
            "license": "2013-00616",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Lynn Skibba, PSY.D.
• Skill Creations Inc
• Skill Creations, Inc.
• Katherine Skillestad, DDS
• Brittany Alexandra Skillman
• Erin Michelle Skinner, COTA
• Kelsey Komyathy Skinner, PHARMD
• Linda Wallace Skinner, CRNA
• Sara Kathleen Skinner, LCSW
• Kaitlyn Skipper, MSW, LCSWA

• Dermatology Physician in Durham, NC
• Providers in Durham, NC by specialty
• Dermatology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.