Vernetta O Jackson, RN,BS,CCM

Primary specialty

Case Management Registered NurseTaxonomy code 163WC0400X

License

375590 Issued in CA

Practice address

4121 W 62ND St
Los Angeles, CA 90043-3612

Phone

(323) 620-0507

NPI assigned

Jul 27, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Van Jackson Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Science, Registered Nurse

State licenses

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

{
    "created_epoch": "1501113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1497279806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4121 W. 62ND ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90043",
            "telephone_number": "323-620-0507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4121 W 62ND ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900433612",
            "telephone_number": "323-620-0507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "VERNETTA",
        "middle_name": "O",
        "name_prefix": "Ms.",
        "credential": "RN,BS,CCM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-07-27",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Case Management",
            "state": "CA",
            "license": "375590",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "VAN",
            "last_name": "JACKSON",
            "credential": "RN,BS,CCM",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Tenika Louise Jackson, PSY.D.
• Thelma Cynthia Jackson, RRT
• Thurman Jackson
• Tiana Amari Jackson
• Titus Clinton Jackson, PA-C
• Victoria Jackson
• Willie D Jackson
• Willie Lee Jackson Jr.
• Willye Dorethea Jackson, MSW
• Xochitl L Jackson, MD

• Case Management Registered Nurse in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Case Management Registered Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.