Active NPI
Latrina Colleen Jackson, RN
- Home Health Registered Nurse
- Raleigh, NC
National Provider Identifier
1669987236
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Registered Nurse
- License
- 210120
- Practice address
- 4922 Windy Hill Dr Ste a
Raleigh, NC 27609-5196 - Phone
- (984) 200-9993
- Fax
- (844) 747-4505
- NPI assigned
- Dec 5, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Management Registered Nurse | 163WC0400X | 210120 | NC | |
| Infusion Therapy Registered Nurse | 163WI0500X | 210120 | NC | |
| Psychiatric/Mental Health Registered Nurse | 163WP0808X | 210120 | NC | |
| Home Health Registered Nurse | 163WH0200X | 210120 | NC | Primary |
Addresses
Primary practice location
4922 Windy Hill Dr Ste a
Raleigh, NC 27609-5196
Mailing address
4922 Windy Hill Dr Ste a
Raleigh, NC 27609-5196
Phone (984) 200-9993
Other practice location 1
4922 Windy Hill Dr Ste A
Raleigh, NC 27609-5196
Phone (984) 200-9993
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 210120 | NC | MD | Psychiatric/Mental Health Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1512432000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521244800000",
"number": "1669987236",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4922 WINDY HILL DR STE A",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276095196",
"telephone_number": "984-200-9993",
"fax_number": "844-747-4505"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4922 WINDY HILL DR STE A",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276095196",
"telephone_number": "984-200-9993",
"fax_number": "844-747-4505"
}
],
"practiceLocations": [
{
"address_1": "4922 Windy Hill Dr Ste A",
"address_purpose": "LOCATION",
"city": "Raleigh",
"state": "NC",
"postal_code": "276095196",
"country_code": "US",
"telephone_number": "984-200-9993",
"fax_number": "844-747-4505",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JACKSON",
"first_name": "LATRINA",
"middle_name": "COLLEEN",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-12-05",
"last_updated": "2018-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "163WC0400X",
"taxonomy_group": "",
"desc": "Registered Nurse, Case Management",
"state": "NC",
"license": "210120",
"primary": false
},
{
"code": "163WI0500X",
"taxonomy_group": "",
"desc": "Registered Nurse, Infusion Therapy",
"state": "NC",
"license": "210120",
"primary": false
},
{
"code": "163WP0808X",
"taxonomy_group": "",
"desc": "Registered Nurse, Psychiatric/Mental Health",
"state": "NC",
"license": "210120",
"primary": false
},
{
"code": "163WH0200X",
"taxonomy_group": "",
"desc": "Registered Nurse, Home Health",
"state": "NC",
"license": "210120",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.