Carla Marie Jackson, APRN

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

1036336 Issued in TX

Practice address

4903 Highway 67 W
Fulton, AR 71838-9033

Phone

(903) 244-5368

NPI assigned

Oct 27, 2022

Sex

Female

Sole proprietor

Yes

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

Enrolled in TX, AR2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Hot Springs Interventional Pain Management PAGroup PAC ID 8527158880, 13 clinicians

Venvisor Health of Ar PAGroup PAC ID 8022551647, 55 clinicians

Practice addresses (Care Compare)

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.

• Venvisor Health of Ar PA

  • Nurse Practitioner
  • Bentonville, AR
  • NPI 1992553028
  Medicare reassignment Care Compare group NPD
• Hot Springs Interventional Pain Management PA

  • Interventional Pain Medicine Physician
  • Hot Springs, AR
  • NPI 1376733824
  Medicare reassignment Care Compare group
• Comprehensive Rehab Consultants PLLC

  • Physical Medicine & Rehabilitation Physician
  • Middle River, MD
  • NPI 1710529771

  TX

  Medicare reassignment NPD
• Wound Management Specialists, LLC

  • Nurse Practitioner
  • Flowood, MS
  • NPI 1972150084

  AR, TX

  Medicare reassignment NPD
• Kirk Mitchell MD PA

  • Nurse Practitioner
  • Fort Worth, TX
  • NPI 1194522730
  NPD

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

{
    "created_epoch": "1666828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666828800000",
    "number": "1710694971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7395",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755057395",
            "telephone_number": "903-244-5368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4903 HIGHWAY 67 W",
            "city": "FULTON",
            "state": "AR",
            "postal_code": "718389033",
            "telephone_number": "903-244-5368"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CARLA",
        "middle_name": "MARIE",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-10-27",
        "last_updated": "2022-10-27",
        "certification_date": "2022-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": "TX",
            "license": "1036336",
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "TX",
            "license": "1036336",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "TX",
            "license": "1036336",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.