Victoria Jackson

Primary specialty

Hemodialysis Registered NurseTaxonomy code 163WH0500X

License

100078 Issued in SC

Practice address

920 Laura St
Bowman, SC 29018-8612

Phone

(803) 354-1011

NPI assigned

Mar 16, 2021

Last updated

Mar 16, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1615852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615852800000",
    "number": "1669057121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 643",
            "city": "BOWMAN",
            "state": "SC",
            "postal_code": "290180643",
            "telephone_number": "803-354-1011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 LAURA ST",
            "city": "BOWMAN",
            "state": "SC",
            "postal_code": "290188612",
            "telephone_number": "803-354-1011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "VICTORIA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-16",
        "last_updated": "2021-03-16",
        "certification_date": "2021-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WH0500X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Hemodialysis",
            "state": "SC",
            "license": "100078",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "SC",
            "license": "100078",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pamela L Crisp, REGISTERED NURSE
• Edisto Regional Health Services Inc (RMC Primary Care Bowman)
• Essential Behavior Counseling Services LLC
• Meredith Taylor Felder
• Mynita S. Harrison, CCC-SLP
• Eric D Keitt
• Latavia Mack
• Mind Matters Solutions LLC
• Michelle Moore
• Musc Community Physicians (MUSC Health Primary Care - Bowman)

• Registered Nurse in Bowman, SC
• Providers in Bowman, SC by specialty
• Registered Nurse in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2021; 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.