Kelly L Donnell-Jackson, RN, MSN, APN-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

26NJ00060400 Issued in NJ

Practice address

1015 Briggs Rd
Mount Laurel, NJ 08054-4115

Phone

(856) 727-0900

Fax

(856) 231-8428

NPI assigned

Jun 19, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NJ, PA2 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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner, Registered Nurse

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kdonnelljackson137589@directvirtua.org

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

• Princeton Endocrinology Associates, LLC

  • Specialist
  • Princeton, NJ
  • NPI 1356587505
  Medicare reassignment NPD
• Virtua Medical Group, PA

  • Family Medicine Physician
  • Marlton, NJ
  • NPI 1649226515
  Medicare reassignment NPD
• Endocrinology Associates, LLC

  • Endocrinology, Diabetes & Metabolism Physician
  • Horsham, PA
  • NPI 1104025709
  Medicare reassignment NPD
• Virtua Medical Group, PA

  • Orthopaedic Surgery Physician
  • Delran, NJ
  • NPI 1841087988

  Nurse Practitioner

  NPD

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

{
    "created_epoch": "1182211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603152000000",
    "number": "1649475765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 LIPPINCOTT DR STE 410",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080534197",
            "telephone_number": "856-355-0340",
            "fax_number": "856-355-0330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 BRIGGS RD",
            "city": "MOUNT LAUREL",
            "state": "NJ",
            "postal_code": "080544115",
            "telephone_number": "856-727-0900",
            "fax_number": "856-231-8428"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "67 Stratton Ln",
            "address_purpose": "LOCATION",
            "city": "Sewell",
            "state": "NJ",
            "postal_code": "080802253",
            "country_code": "US",
            "telephone_number": "856-889-9577",
            "fax_number": "856-753-7714",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DONNELL-JACKSON",
        "first_name": "KELLY",
        "middle_name": "L",
        "credential": "RN, MSN, APN-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-19",
        "last_updated": "2020-10-20",
        "certification_date": "2020-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NJ",
            "license": "26NR09192400",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "SP010454",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NJ",
            "license": "26NJ00060400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kdonnelljackson137589@directvirtua.org",
            "affiliation": "N",
            "address_1": "1015 Briggs Rd",
            "city": "Mount Laurel",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080544115",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Doc Love Homecare
• Katrina Dodson, OT
• Alana Dolan
• Stefan Carl Dombrowski, PH.D.
• Lauren Ashley Donlon, APN
• Alexandra Catherine Dorn
• Chiquita Dotson, M.A., CCC-SLP
• Donna Doulong, PTA
• Stephanie Downes, BSN, RN
• Felicia Dragon

• Family Nurse Practitioner in Mount Laurel, NJ
• Providers in Mount Laurel, NJ by specialty
• Family Nurse Practitioner in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2020; 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.

Verify at the official NPI Registry.