Jasmine Shanae Jackson, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

0024178156 Issued in VA

Practice address

3400 S Crater Rd Ste B
Petersburg, VA 23805

Phone

(804) 733-6960

NPI assigned

Sep 4, 2019

Sex

Female

Sole proprietor

No

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 VA, WV, UT, AR, NH5 enrollments

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 5

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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.

• Virta Medical P.C.

  • Internal Medicine Physician
  • San Francisco, CA
  • NPI 1093225138

  AR, NH, UT, VA, WV

  Medicare reassignment

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

{
    "created_epoch": "1567555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567728000000",
    "number": "1578112496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 S CRATER RD STE B",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238059252",
            "telephone_number": "804-733-6960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 S CRATER RD STE B",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "23805",
            "telephone_number": "804-733-6960"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9000 Staples Mill Rd",
            "address_purpose": "LOCATION",
            "city": "Henrico",
            "state": "VA",
            "postal_code": "232282021",
            "country_code": "US",
            "telephone_number": "804-977-9526",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JASMINE",
        "middle_name": "SHANAE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-04",
        "last_updated": "2019-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024178156",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Iveyhouse LTD.
• Ivy Counseling Center LLC
• J. Houseworth, DPM LLC
• Jackson Professional Serv LLC
• Alexandrea J Jackson, LPC
• Lauran Dekease Jackson
• Sara Jackson
• Valecia Jackson, CSAC
• Rachael Jadidi, FNP
• Iteisha James-Crenshaw, LCSW

• Family Nurse Practitioner in Petersburg, VA
• Providers in Petersburg, VA by specialty
• Family Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.