Heather Elizabeth Jackson, ACNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

4704214316 Issued in MI

Practice address

6286 Pepper Hill St
West Bloomfield, MI 48322-2301

Phone

(313) 400-8007

NPI assigned

Aug 8, 2013

Last updated

Jul 6, 2023By 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 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Interoperability endpoints

• Direct secure messaging: hjackson4@direct.dmc.org

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

{
    "created_epoch": "1375920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688601600000",
    "number": "1649602905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6286 PEPPER HILL ST",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "483222301",
            "telephone_number": "313-400-8007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6286 PEPPER HILL ST",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "483222301",
            "telephone_number": "313-400-8007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "HEATHER",
        "middle_name": "ELIZABETH",
        "credential": "ACNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-08",
        "last_updated": "2023-07-06",
        "certification_date": "2023-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704214316",
            "primary": true
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MI",
            "license": "4704214316",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ghalib Issaq, D.D.S.
• J. Kahn Corporation
• Joleen Jabro
• Diane M. Jackson-Richards, M.D.
• Diana Jackson, L.P.N.
• Karen Jackson
• Lynn Jackson
• Payton Jackson III, LMSW
• Rodger Dale Jackson Jr., DO, MPH
• Jacob Kalo, M.D.

• Nurse Practitioner in West Bloomfield, MI
• Providers in West Bloomfield, MI by specialty
• Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.