Active NPI
Vanessa Jackson, CRNP
- Family Nurse Practitioner
- Birmingham, AL
National Provider Identifier
1487975520
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 2010002394
- Practice address
- 3700 Cahaba Beach Rd
Birmingham, AL 35242-5225 - Phone
- (052) 512-5464
- NPI assigned
- Jun 11, 2010
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 2010002394 | AL | Primary |
Addresses
Primary practice location
3700 Cahaba Beach Rd
Birmingham, AL 35242-5225
Mailing address
101 Delia LN
Marion, AL 36756-3106
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487975520 | Medicaid | AL |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2010002394 | AL | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1276214400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1582243200000",
"number": "1487975520",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 DELIA LN",
"city": "MARION",
"state": "AL",
"postal_code": "367563106"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3700 CAHABA BEACH RD",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352425225",
"telephone_number": "052-512-5464"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "VANESSA",
"credential": "CRNP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-06-11",
"last_updated": "2020-02-21",
"certification_date": "2020-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "AL",
"license": "2010002394",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1487975520",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Birmingham, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.