Nicole Stanley Jackson, NP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN143548 Issued in GA

Practice address

116 Smith St
Tennille, GA 31089-1465

Phone

(478) 552-1620

Fax

(478) 864-1288

NPI assigned

Jul 7, 2014

Last updated

Oct 24, 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 1

Addresses

Other identifiers 2

Other names 1

• Sharon S Massengale Former name

Medicare fee-for-service enrollment

Enrolled in GA

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 1

Medicare enrollment (NPD)

Enrolled

Practice roles

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

• Community Health Care Systems, Inc.

  dba Johnson County Center for Community Health

  • Federally Qualified Health Center (FQHC)
  • Wrightsville, GA
  • NPI 1932150422
  Medicare reassignment
• Community Health Care Systems, Inc.

  dba Community Health Care Systems-Twiggs

  • Federally Qualified Health Center (FQHC)
  • Jeffersonville, GA
  • NPI 1194996421
  NPD

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

{
    "created_epoch": "1404691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698105600000",
    "number": "1659787034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 371",
            "city": "WRIGHTSVILLE",
            "state": "GA",
            "postal_code": "310960371",
            "telephone_number": "478-864-3448",
            "fax_number": "478-864-1288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 SMITH ST",
            "city": "TENNILLE",
            "state": "GA",
            "postal_code": "310891465",
            "telephone_number": "478-552-1620",
            "fax_number": "478-864-1288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "NICOLE",
        "middle_name": "STANLEY",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-07",
        "last_updated": "2023-10-24",
        "certification_date": "2023-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN143548",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICAN ACADEMY OF NURSE PRACTITIONERS",
            "identifier": "F0414179",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEORGIA SECRETARY OF STATE",
            "identifier": "RN143548",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHARON",
            "last_name": "MASSENGALE",
            "middle_name": "S",
            "credential": "NP-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• April Babb Crisp, M.S., LPC
• Debra Durden, APRN
• Alesha Michelle Edwards, D.P.M.
• Extending a Hand Home Care
• Pamela Fowler
• JDH Home Healthcare
• Tanya Yvonne Jones, M.D.
• Jada Breyle Jordan
• Ramekia N Jordan
• Lisa G Lamar, CERTIFIEDHHHIDE

• Family Nurse Practitioner in Tennille, GA
• Providers in Tennille, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2023; 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.