Stacey Renee Jackson, NP

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

AP130643 Issued in TX

Practice address

906 W Randol Mill Rd
Arlington, TX 76012-2510

Phone

(817) 261-4906

Fax

(817) 261-5837

NPI assigned

May 12, 2016

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

Medicare fee-for-service enrollment

Enrolled in DE

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

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• Delaware Hospice, Inc

  • Hospice and Palliative Medicine (Family Medicine) Physician
  • Newark, DE
  • NPI 1821361072
  Medicare reassignment NPD

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

{
    "created_epoch": "1463011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469145600000",
    "number": "1669828224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "906 W RANDOL MILL RD",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760122510",
            "telephone_number": "817-261-4906",
            "fax_number": "817-261-5837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "906 W RANDOL MILL RD",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760122510",
            "telephone_number": "817-261-4906",
            "fax_number": "817-261-5837"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "STACEY",
        "middle_name": "RENEE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-05-12",
        "last_updated": "2016-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TX",
            "license": "AP130643",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paola Jackson
• Renee Jackson
• Robert Jackson, PTA
• Sedrick Wales Jackson
• Sonja Jackson, LPC
• Nimisha Jacob
• Sajish Eapen Jacob, M.D.
• Harmon Voss Jacobs, DDS
• David Jacobson
• Jae'S House of Hope LLC

• Acute Care Nurse Practitioner in Arlington, TX
• Providers in Arlington, TX by specialty
• Acute Care Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2016; 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.