Susan Marie Jackson, CNP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

CNP.13953 Issued in OH

Practice address

4805 Montgomery Rd Ste 410
Cincinnati, OH 45212

Phone

(513) 559-1222

Fax

(513) 559-1235

NPI assigned

Feb 21, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

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.

• Lima Memorial Joint Operating Company

  dba Lima Memorial Health System

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732
  NPD (past)
• Riverhills Healthcare, Inc.

  • Neurological Surgery Physician
  • Cincinnati, OH
  • NPI 1740386440
  NPD (past)

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

{
    "created_epoch": "1361404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526515200000",
    "number": "1689914087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4805 MONTGOMERY RD STE 150",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452122280",
            "telephone_number": "513-961-5558",
            "fax_number": "513-961-1912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4805 MONTGOMERY RD STE 410",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "45212",
            "telephone_number": "513-559-1222",
            "fax_number": "513-559-1235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SUSAN",
        "middle_name": "MARIE",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-02-21",
        "last_updated": "2018-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "OH",
            "license": "CNP.13953",
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "KY",
            "license": "1135253",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OH",
            "license": "RN.259883-COA1",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shariyah Jackson
• Shauntinique D Jackson
• Shawna Jackson, NP
• Sonnetta Kay Jackson, LPN
• St.John Jackson
• Tamika Jackson
• Tangie Jackson
• Tedroy Mevrick Jackson, MD
• Terrence Jackson
• Thomas Jackson

• Adult Health Nurse Practitioner in Cincinnati, OH
• Providers in Cincinnati, OH by specialty
• Adult Health Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2018; 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.