Active NPI
Jeanne Marie Jackson, FNP
- Nurse Practitioner
- Ontario, CA
National Provider Identifier
1508622150
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 705082
- Practice address
- 3734 Santiago Creek Way
Ontario, CA 91761-0203 - Phone
- (909) 582-5140
- NPI assigned
- Feb 22, 2024
- 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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 705082 | CA | Primary |
Addresses
Primary practice location
3734 Santiago Creek Way
Ontario, CA 91761-0203
Mailing address
3734 Santiago Creek Way
Ontario, CA 91761-0203
Phone (909) 582-5140
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 705082 | CA | MD | Nurse Practitioner |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/EECJBD
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1708560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1708992000000",
"number": "1508622150",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3734 SANTIAGO CREEK WAY",
"city": "ONTARIO",
"state": "CA",
"postal_code": "917610203",
"telephone_number": "909-582-5140"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3734 SANTIAGO CREEK WAY",
"city": "ONTARIO",
"state": "CA",
"postal_code": "917610203",
"telephone_number": "909-582-5140"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "JEANNE",
"middle_name": "MARIE",
"credential": "FNP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-02-22",
"last_updated": "2024-02-27",
"certification_date": "2024-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "CA",
"license": "705082",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ontario, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.