Kellontreia Laporche Jackson, A-GNP-C

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

NP259383 Issued in GA

Practice address

37 341 Byp
Hawkinsville, GA 31036-4839

Phone

(478) 845-4842

NPI assigned

Nov 9, 2022

Last updated

May 13, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 6

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA, CO, TX, IA, TN, MI6 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 6

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Topaz Bay Senior Health PCGroup PAC ID 2860906385, 30 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations (25 of 33)

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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

• Topaz Bay Senior Health PC

  • Geriatric Medicine (Internal Medicine) Physician
  • Hoboken, NJ
  • NPI 1194518134

  GA

  Medicare reassignment Care Compare group NPD
• CH Specialty Services Ga LLC

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1306545181
  Medicare reassignment NPD
• Curana Health of Georgia LLC

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1043605314

  Nurse Practitioner

  Medicare reassignment NPD
• Qcpi-Villagemd, PC

  dba Village Medical

  • Family Medicine Physician
  • Atlanta, GA
  • NPI 1558872432
  Medicare reassignment NPD
• Wellbe Senior Medical Group of Georgia, P. C.

  dba WellBe Senior Medical

  • Internal Medicine Physician
  • Sandy Springs, GA
  • NPI 1205463163
  Medicare reassignment NPD
• Complexcare Medical Group Midwest M PLLC

  • Internal Medicine Physician
  • Novi, MI
  • NPI 1528851607

  Nurse Practitioner

  Medicare reassignment NPD
• Curana Health Medical Group LLC

  • Internal Medicine Physician
  • Austin, TX
  • NPI 1255640678

  GA, Nurse Practitioner

  Medicare reassignment NPD
• Qofl Services LLC

  • Nurse Practitioner
  • Louisville, KY
  • NPI 1942554837

  GA

  Medicare reassignment NPD
• Theoria Medical

  • Internal Medicine Physician
  • Novi, MI
  • NPI 1609362375

  CO, GA, IA, Nurse Practitioner, TN, TX

  Medicare reassignment NPD
• Georgia Mso LLC

  • Family Medicine Physician
  • Atlanta, GA
  • NPI 1952196164
  Medicare reassignment
• Applebaum Physiatry PLLC

  • Physical Medicine & Rehabilitation Physician
  • Oak Brook, IL
  • NPI 1700598059

  GA

  Medicare reassignment
• Complexcare Medical Group Midwest H PLLC

  • Internal Medicine Physician
  • Novi, MI
  • NPI 1457144933
  Medicare reassignment

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

{
    "created_epoch": "1667952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778630400000",
    "number": "1619685534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4196 HIGHWAY 62 412 STE A",
            "city": "HARDY",
            "state": "AR",
            "postal_code": "725428002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37 341 BYP",
            "city": "HAWKINSVILLE",
            "state": "GA",
            "postal_code": "310364839",
            "telephone_number": "478-845-4842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KELLONTREIA",
        "middle_name": "LAPORCHE",
        "credential": "A-GNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-11-09",
        "last_updated": "2026-05-13",
        "certification_date": "2026-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MI",
            "license": "4704420181",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "GA",
            "license": "NP259383",
            "primary": true
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "TX",
            "license": "1176633",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "IA",
            "license": "H181146",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "CO",
            "license": "C-APN.0102805-C-NP",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "TN",
            "license": "36993",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "kellontreiajackson@gmail.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "100 Knight Way Apt 602",
            "city": "Fayetteville",
            "state": "GA",
            "country_code": "US",
            "postal_code": "302141797",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jaclyn Howard, PHARM D
• Independence in Home Care
• Independence in-Home Care
• Independence in-Home Care
• Kayci Morgan Jackson, PHARM.D
• Megan B Jacobs, PHARMD.
• Rheal Adrien Janelle Jr., RPH
• Brandi S Jernander, NP-C
• Stephanie Watkins Kirkland, RPH
• Sandra S Kopacz, MD

• Gerontology Nurse Practitioner in Hawkinsville, GA
• Providers in Hawkinsville, GA by specialty
• Gerontology Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2026; 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.