Active NPI
Khristie Jackson
- Registered Nurse
- Gastonia, NC
National Provider Identifier
1710344288
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 231925
- Practice address
- 991 W Hudson Blvd
Gastonia, NC 28052-6430 - Phone
- (704) 853-5085
- NPI assigned
- Jan 28, 2016
- 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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 231925 | SC | 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) 853-5085
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 |
|---|---|---|---|
| 231925 | SC | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1453939200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1453939200000",
"number": "1710344288",
"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": "704-853-5085"
},
{
"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": "704-853-5085"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "KHRISTIE",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-01-28",
"last_updated": "2016-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "SC",
"license": "231925",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"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 Jan 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.