Heidi Ericka Jackson, RN

Primary specialty

Community Health Registered NurseTaxonomy code 163WC1500X

License

201801572RN Issued in OR

Practice address

15606 NE 12TH Way
Vancouver, WA 98684

Phone

(541) 401-3098

NPI assigned

Oct 25, 2018

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1540425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540425600000",
    "number": "1699242826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15606 NE 12TH WAY",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986844158",
            "telephone_number": "541-401-3098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15606 NE 12TH WAY",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "98684",
            "telephone_number": "541-401-3098"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15606 ne 12th way",
            "address_purpose": "LOCATION",
            "city": "Vancouver",
            "state": "WA",
            "postal_code": "98684",
            "country_code": "US",
            "telephone_number": "541-401-3098",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "HEIDI",
        "middle_name": "ERICKA",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-10-25",
        "last_updated": "2018-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC1500X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Community Health",
            "state": "OR",
            "license": "201801572RN",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittany Kassandra Jackson, MA PPS APCC LMHCA
• Corynne M Jackson
• David Andrew Jackson
• Dean Robert Jackson, LMP
• Emma Jackson
• Jasmine Kay Jackson
• Jefferson T Jackson
• Keith Ellis Jackson, LMFT
• Liberty Zariah Jackson, OTR/L
• Makenah Lorraine Jackson

• Community Health Registered Nurse in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Community Health Registered Nurse in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 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.

Verify at the official NPI Registry.