Active NPI
Kelli Johnson Jackson
- Optometrist
- Nashville, TN
National Provider Identifier
1639190051
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1566
- Practice address
- 6814 Charlotte Pike
Nashville, TN 37209-4206 - Phone
- (615) 352-9699
- NPI assigned
- Jul 21, 2006
- 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 |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1566 | TN | Primary |
Addresses
Primary practice location
6814 Charlotte Pike
Nashville, TN 37209-4206
Mailing address
1221 Buckhead Dr
Brentwood, TN 37027-7878
Phone (615) 837-8422
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3940088 | Medicaid | TN | |
| P00265658 | Other | TN | RAILROAD MEDICARE PROV # |
| 4134928 | Other | TN | BCBS & TNCARE SELECT # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051018001076 | TN | Practitioner - Optometry | 5496771511 | Practice locations: Manchester, TN; Mount Juliet, TN; Mount Pleasant, TN; Murfreesboro, TN; Nashville, TN; Franklin, TN; Palmyra, TN; Pulaski, TN… |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1566 | TN | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1559520000000",
"number": "1639190051",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1221 BUCKHEAD DR",
"city": "BRENTWOOD",
"state": "TN",
"postal_code": "370277878",
"telephone_number": "615-837-8422"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6814 CHARLOTTE PIKE",
"city": "NASHVILLE",
"state": "TN",
"postal_code": "372094206",
"telephone_number": "615-352-9699"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "KELLI",
"middle_name": "JOHNSON",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-21",
"last_updated": "2019-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "TN",
"license": "1566",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3940088",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE PROV #",
"identifier": "P00265658",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS & TNCARE SELECT #",
"identifier": "4134928",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Nashville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 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.