Kalita Higginbotham Jackson, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN191958 Issued in GA

Practice address

500 Medical Center Blvd Ste 310
Lawrenceville, GA 30046-3332

Phone

(678) 629-7139

NPI assigned

Mar 1, 2012

Sex

Female

Sole proprietor

Yes

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 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

Credentials

Nurse Practitioner

State licenses

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.

• Gwinnett Hospital System Gme, LLC

  • Family Medicine Physician
  • Lawrenceville, GA
  • NPI 1780076927
  Medicare reassignment NPD
• Northside Hospital, Inc.

  • General Acute Care Hospital
  • Lawrenceville, GA
  • NPI 1952340994
  Medicare reassignment NPD
• The Emory Clinic Inc

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1396798229
  Medicare reassignment NPD
• Minuteclinic LLC

  • Family Nurse Practitioner
  • Rockville, MD
  • NPI 1134191836

  GA

  Medicare reassignment NPD
• Gwinnett Pathology Assoc PC

  • Anatomic Pathology & Clinical Pathology Physician
  • Lawrenceville, GA
  • NPI 1104887330
  NPD
• Northside Hospital, Inc.

  • General Acute Care Hospital
  • Duluth, GA
  • NPI 1790715381
  NPD
• Santana Transitions MHT LLC

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1902281355
  NPD (past)

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

{
    "created_epoch": "1330560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581120000000",
    "number": "1679847057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 MEDICAL CENTER BLVD STE 310",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300463332",
            "telephone_number": "678-629-7139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 MEDICAL CENTER BLVD STE 310",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300463332",
            "telephone_number": "678-629-7139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KALITA",
        "middle_name": "HIGGINBOTHAM",
        "name_prefix": "Mrs.",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-03-01",
        "last_updated": "2020-02-08",
        "certification_date": "2020-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN191958",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deborah Jackson, COTA/L
• Ethan Gainor Jackson, PT, DPT
• George Darryl Jackson, M.S.
• India Jackson
• Joanne V Jackson, MD
• Kansington Caroline Jackson
• Keilon Latrice Jackson, CMA
• Kelly Len Jackson, N.P.
• Marshalee Jackson
• Rebecca Dott Jackson, PA-C

• Family Nurse Practitioner in Lawrenceville, GA
• Providers in Lawrenceville, 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 Feb 8, 2020; 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.