Active NPI
Jessica Rechelle Jackson, DDS
- General Practice Dentistry
- Gastonia, NC
National Provider Identifier
1689169260
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 11511
- Practice address
- 991 W Hudson Blvd
Gastonia, NC 28052-6430 - Phone
- (704) 853-5191
- Fax
- (704) 671-1404
- NPI assigned
- Jun 26, 2018
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 11511 | NC | Primary |
Addresses
Primary practice location
991 W Hudson Blvd
Gastonia, NC 28052-6430
Mailing address
991 W Hudson Blvd
Gastonia, NC 28052-6430
Phone (704) 853-5191
Other practice location 1
518 Brookdale Dr
Statesville, NC 28677-4108
Phone (704) 838-1108
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | direct | Direct | Gaston Family Health Services, Inc. |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11511 | NC | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1529971200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701043200000",
"number": "1689169260",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "991 W HUDSON BLVD",
"city": "GASTONIA",
"state": "NC",
"postal_code": "280526430",
"telephone_number": "704-853-5191",
"fax_number": "704-671-1404"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "991 W HUDSON BLVD",
"city": "GASTONIA",
"state": "NC",
"postal_code": "280526430",
"telephone_number": "704-853-5191",
"fax_number": "704-671-1404"
}
],
"practiceLocations": [
{
"address_1": "518 Brookdale Dr",
"address_purpose": "LOCATION",
"city": "Statesville",
"state": "NC",
"postal_code": "286774108",
"country_code": "US",
"telephone_number": "704-838-1108",
"fax_number": "704-671-1404",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JACKSON",
"first_name": "JESSICA",
"middle_name": "RECHELLE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-06-26",
"last_updated": "2023-11-27",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NC",
"license": "11511",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "direct",
"affiliation": "Y",
"affiliationName": "Gaston Family Health Services, Inc.",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "991 W Hudson Blvd",
"city": "Gastonia",
"state": "NC",
"country_code": "US",
"postal_code": "280526430",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Gastonia, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.