Active NPI
Nancy Jackson, RN PNP
- Nurse Practitioner
- Augusta, GA
National Provider Identifier
1487615191
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- R110128
- Practice address
- 1115 Garredd Blvd
Augusta, GA 30909 - Phone
- (706) 854-9416
- Fax
- (706) 863-8523
- NPI assigned
- Mar 31, 2006
- Last updated
- Jul 13, 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 | R110128 | GA | Primary |
Addresses
Primary practice location
1115 Garredd Blvd
Augusta, GA 30909
Mailing address
1115 Garredd Blvd
Augusta, GA 30909
Phone (706) 854-9416
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00876939A | Medicaid | GA |
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
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R110128 | GA | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143763200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1487615191",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1115 GARREDD BLVD",
"city": "AUGUSTA",
"state": "GA",
"postal_code": "30909",
"telephone_number": "706-854-9416",
"fax_number": "706-863-8523"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1115 GARREDD BLVD",
"city": "AUGUSTA",
"state": "GA",
"postal_code": "30909",
"telephone_number": "706-854-9416",
"fax_number": "706-863-8523"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "NANCY",
"credential": "RN PNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-31",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "GA",
"license": "R110128",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00876939A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Augusta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 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.