Kelli Jackson

Primary specialty

OptometristTaxonomy code 152W00000X

License

1566 Issued in TN

Legal business name

KELLI JACKSON

Practice address

114 Stuart Rd NE
#102
Cleveland, TN 37312-4803

Phone

(252) 985-1371

NPI assigned

Mar 20, 2007

Organization subpart

No

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

Authorized official

Name

Kelli J Jackson, OD

Title

Optometrist

Phone

(252) 985-1371

Specialties & licenses 1

Addresses

Other identifiers 3

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215043200000",
    "number": "1619092574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7396",
            "city": "ROCKY MOUNT",
            "state": "NC",
            "postal_code": "278040396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 STUART RD NE",
            "address_2": "#102",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "373124803",
            "telephone_number": "252-985-1371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLI JACKSON",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-20",
        "last_updated": "2008-07-03",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "KELLI",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "252-985-1371",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "TN",
            "license": "1566",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00265658",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3940088",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "4134928",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shobha Karwan, MD
• Leslie Eileen Kay, LPC
• Andrea Michelle Keith, FNP-C
• Cassie Keller, DPH
• Melody Rae Wallace Kelley, CBD (AWWS)
• Taylor Nichole Kelso
• Ajitkumar Kemkar, MD
• Kenneth E. Beard, DDS,PC
• Casey Ann Kent, DC
• Miranda Keplinger, LPC-MHSP

• Optometrist in Cleveland, TN
• Providers in Cleveland, TN by specialty
• Optometrist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2008; 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.