Kristina Gayle Jackson, C.R.N.A.

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

APN 15075 Issued in TN

Practice address

755 N 11TH St
Suite P3600
Beaumont, TX 77702-1500

Phone

(409) 838-5214

NPI assigned

Mar 10, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

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

{
    "created_epoch": "1268179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424822400000",
    "number": "1558684183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5587",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777265587",
            "telephone_number": "409-838-5214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "755 N 11TH ST",
            "address_2": "SUITE P3600",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777021500",
            "telephone_number": "409-838-5214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KRISTINA",
        "middle_name": "GAYLE",
        "credential": "C.R.N.A.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-03-10",
        "last_updated": "2015-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TN",
            "license": "RN0000142813",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TN",
            "license": "APN 15075",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF TN",
            "identifier": "4266382",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07805512",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00907129",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1521274",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS/HUMANA TRICARE",
            "identifier": "1558684183",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• J a M Daycare Health and Services LLC
• J.C.V.K. Inc.
• Jackson T. Achilles, MD PA
• Christine S Jackson, NP-C
• Jennifer Beth Jackson, FNP-C
• Sharon K. Jackson, O.T.R.
• Marcusella Stevenson Jagneaux, D.C.
• Nicole Yvette Jaikaran, M.D.
• Pragya Jain, MD
• Abdullah Jamal

• Certified Registered Nurse Anesthetist in Beaumont, TX
• Providers in Beaumont, TX by specialty
• Certified Registered Nurse Anesthetist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2015; 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.