Kelley J Jackson, WHNP

Primary specialty

Women's Health Nurse PractitionerTaxonomy code 363LW0102X

License

95026533 Issued in CA

Practice address

1095 Marshall Way
Placerville, CA 95667-5722

Phone

(530) 344-5470

NPI assigned

Aug 8, 2023

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

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

University of Cincinnati College of Medicine, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Marshall Medical Center 168 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Marshall Medical Center Hospital, Placerville, CA, CCN 050254

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Marshall Medical Center

  • Family Medicine Physician
  • El Dorado Hills, CA
  • NPI 1114727377

  CA, Single Specialty

  Medicare reassignment Care Compare group NPD
• Marshall Medical Center

  • Rural Health Clinic/Center
  • Georgetown, CA
  • NPI 1346226693
  Care Compare group
• Marshall Medical Center

  • Rural Health Clinic/Center
  • Placerville, CA
  • NPI 1386065480
  Care Compare group
• Marshall Medical Center

  • Community/Retail Pharmacy
  • Cameron Park, CA
  • NPI 1447912191
  Care Compare group
• Marshall Medical Center

  • Rehabilitation Clinic/Center
  • El Dorado Hills, CA
  • NPI 1972309326
  Care Compare group
• Marshall Medical Center

  • General Acute Care Hospital
  • Placerville, CA
  • NPI 1972503142
  Care Compare group
• Marshall Medical Center

  • Home Health Agency
  • Diamond Springs, CA
  • NPI 1992705040
  Care Compare group
• Marshall Medical Center

  • Family Medicine Physician
  • Placerville, CA
  • NPI 1962506097
  NPD
• Marshall Medical Center

  • Interventional Cardiology Physician
  • Placerville, CA
  • NPI 1215181664
  NPD (past)
• Marshall Medical Center

  • Obstetrics Physician
  • Placerville, CA
  • NPI 1609062389
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Marshall Medical Center

  • General Acute Care Hospital
  • Placerville, CA
  • NPI 1972503142

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1691452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691452800000",
    "number": "1558044644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1550 IRON POINT RD APT 1312",
            "city": "FOLSOM",
            "state": "CA",
            "postal_code": "956307814",
            "telephone_number": "916-202-8490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1095 MARSHALL WAY",
            "city": "PLACERVILLE",
            "state": "CA",
            "postal_code": "956675722",
            "telephone_number": "530-344-5470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KELLEY",
        "middle_name": "J",
        "credential": "WHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-08-08",
        "last_updated": "2023-08-08",
        "certification_date": "2023-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "CA",
            "license": "95026533",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• In Hee Song DMD, MD, Inc
• Nicklaus Ingman, PT, DPT
• Injoo Han,D.D.S.,Inc.
• Institute of Family Counseling
• Melissa Izzi, OTR
• Rochelle Jagdeo, M.D.
• James H Hastings DDS a Prof Corp
• Judy Rose James, RN
• Jenny Ramirez Jandoc, RN
• Mitchell Dale Jankowski, R1381900320

• All providers in Placerville, CA
• Women's Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.