Kellontreia Laporche Jackson, A-GNP-C
Individual provider Active NPI Gerontology Nurse Practitioner · Hawkinsville, GA
NPI 1619685534 · NPPES record last updated May 13, 2026
Key facts
- NPI
- 1619685534
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Gerontology Nurse Practitioner 363LG0600X
- License
- NP259383 (GA)
- Practice address
- 37 341 Byp
Hawkinsville, GA 31036-4839 - Phone
- (478) 845-4842
- NPI assigned
- Nov 9, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 17
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Topaz Bay Senior Health PC
Practice addresses (Care Compare)
3455 Peachtree Rd NE
Suite 5
Atlanta, GA 30326-3254
Phone (203) 666-8145
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (6 enrollments) in GA, CO, TX, IA, TN, MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221111000944 | GA | Practitioner - Nurse Practitioner | 0446627947 | Reassigns benefits to 10 organizations |
| I20241023003825 | CO | Practitioner - Nurse Practitioner | 0446627947 | Reassigns benefits to 1 organization |
| I20250424002817 | TX | Practitioner - Nurse Practitioner | 0446627947 | Reassigns benefits to 1 organization |
| I20250425001776 | IA | Practitioner - Nurse Practitioner | 0446627947 | Reassigns benefits to 1 organization |
| I20250522001651 | TN | Practitioner - Nurse Practitioner | 0446627947 | Reassigns benefits to 1 organization |
| I20251113001854 | MI | Practitioner - Nurse Practitioner | 0446627947 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C-APN.0102805-C-NP | CO | MD | Gerontology Nurse Practitioner |
| NP259383 | GA | MD | Gerontology Nurse Practitioner |
| H181146 | IA | MD | Gerontology Nurse Practitioner |
| 4704420181 | MI | MD | Gerontology Nurse Practitioner |
| 36993 | TN | MD | Gerontology Nurse Practitioner |
| 1176633 | TX | MD | Gerontology Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Complexcare Medical Group Midwest M PLLC | Nurse Practitioner | Current |
Accepting new patients |
| Total Care Family Practice Rick Bobay LLC | Nurse Practitioner | Current |
Accepting new patients |
| Post Acute Specialists, LLC | Current |
Accepting new patients | |
| Texas Post Acute Specialists, PA | Current |
Accepting new patients | |
| Theoria Medical | Nurse Practitioner | Current |
Accepting new patients |
| Mi Post Acute Specialists PC | Current |
Accepting new patients | |
| Curana Health Medical Group LLC | Nurse Practitioner | Current |
Accepting new patients |
| Curana Health of Georgia LLC | Nurse Practitioner | Current |
Accepting new patients |
| Qcpi-Villagemd, PC | Current |
Accepting new patients | |
| Wellbe Senior Medical Group of Georgia, P. C. | Current |
Accepting new patients | |
| Qofl Services LLC | Nurse Practitioner | Current |
Accepting new patients |
| CH Specialty Services Ga LLC | Current |
Accepting new patients | |
| Topaz Bay Senior Health PC | Current |
Accepting new patients | |
| Total Care Family Practice Rick Bobay LLC | Nurse Practitioner | Past |
Accepting new patients |
Locations (25 of 33)
2501 Little Bookcliff Dr
Grand Junction, CO 81501
Phone (970) 245-1211
1660 Allison St
Lakewood, CO 80214
Phone (303) 232-7177
1401 S Cascade Ave
Montrose, CO 81401
Phone (970) 249-9634
99 Hawley Ln
Ste 1102
Stratford, CT 06614
3445 Peachtree Rd NE
Ste 1200
Atlanta, GA 30326
Phone (404) 407-1664
3455 Peachtree Rd NE
#5
Atlanta, GA 30326
3355 Lenox Rd NE
Ste 750
Atlanta, GA 30326
Phone (470) 682-3536
2541 Milledgeville Rd
Augusta, GA 30904
Phone (706) 735-2581
1397 US 41 N
Calhoun, GA 30701
37 341 Byp
Hawkinsville, GA 31036
Phone (478) 845-4842
239 Arrowhead Blvd
Jonesboro, GA 30236
Phone (404) 312-0496
1901 W Screven St
Quitman, GA 31643
Phone (229) 263-6100
5 Concourse Pkwy
Ste 3100
Sandy Springs, GA 30328
Phone (855) 492-7642
1825 Rockbridge Rd
Ste 15B
Stone Mtn, GA 30087
Phone (470) 444-3134
1805 Parke Plaza Cir
Ste 101
Stone Mtn, GA 30087
Phone (770) 469-7000
7300 Lester Rd
Union City, GA 30291
Phone (770) 703-2604
2001 1st Ave N
Estherville, IA 51334
Phone (712) 362-3594
12910 Shelbyville Rd
Ste 300
Louisville, KY 40243
Phone (502) 214-0693
5655 Clarkston Rd
Clarkston, MI 48348
Phone (810) 623-5216
6700 W Outer Dr
Detroit, MI 48235
Phone (313) 836-1700
3139 E Baldwin Rd
Grand Blanc, MI 48439
Phone (810) 445-5300
41800 W 11 Mile Rd
Ste 109
Novi, MI 48375
Phone (833) 578-2763
55378 Wilbur Rd
Three Rivers, MI 49093
Phone (269) 279-7441
1 Veterans Way
Knoxville, TN 37931
Phone (855) 240-2530
141 N McLean Blvd
Memphis, TN 38104
Phone (901) 276-2020
Interoperability endpoints
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gerontology Nurse Practitioner | 363LG0600X | 4704420181 | MI | |
| Gerontology Nurse Practitioner | 363LG0600X | NP259383 | GA | Yes |
| Gerontology Nurse Practitioner | 363LG0600X | 1176633 | TX | |
| Gerontology Nurse Practitioner | 363LG0600X | H181146 | IA | |
| Gerontology Nurse Practitioner | 363LG0600X | C-APN.0102805-C-NP | CO | |
| Gerontology Nurse Practitioner | 363LG0600X | 36993 | TN |
Addresses
Primary practice location
37 341 Byp
Hawkinsville, GA 31036-4839
Mailing address
4196 Highway 62 412 Ste a
Hardy, AR 72542-8002
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | kellontreiajackson@gmail.com | Health Information Exchange (HIE) |
Other providers in Hawkinsville, GA
- Jaclyn Howard
- Independence in Home Care
- Independence in-Home Care
- Independence in-Home Care
- Kayci Morgan Jackson
- Megan B Jacobs
- Rheal Adrien Janelle Jr.
- Brandi S Jernander
- Stephanie Watkins Kirkland
- Sandra S Kopacz
All providers in Hawkinsville, GA · Gerontology Nurse Practitioner in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 13, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.