Active NPI
Renee Jackson
- Specialist
- Omaha, NE
National Provider Identifier
1629997374
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- Practice address
- 2930 N 108TH St
Omaha, NE 68164-3710 - Phone
- (402) 709-1964
- NPI assigned
- Jul 14, 2026
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | Primary |
Addresses
Primary practice location
2930 N 108TH St
Omaha, NE 68164-3710
Mailing address
2027 N 83Rd St
Omaha, NE 68134-6301
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1783987200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783987200000",
"number": "1629997374",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2027 N 83RD ST",
"city": "OMAHA",
"state": "NE",
"postal_code": "681346301"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2930 N 108TH ST",
"city": "OMAHA",
"state": "NE",
"postal_code": "681643710",
"telephone_number": "402-709-1964"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "RENEE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2026-07-14",
"last_updated": "2026-07-14",
"certification_date": "2026-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Specialist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.