Jill Jackson, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

322734-1 Issued in NY

Practice address

265 Kissel Ave
Staten Island, NY 10310-1623

Phone

(718) 490-4946

NPI assigned

Oct 6, 2015

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

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

State licenses

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

{
    "created_epoch": "1444089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1444089600000",
    "number": "1730559535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "265 KISSEL AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103101623",
            "telephone_number": "718-490-4946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "265 KISSEL AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103101623",
            "telephone_number": "718-490-4946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JILL",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-10-06",
        "last_updated": "2015-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "322734-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jack Basil Dangelo Jr
• Jack Miceli DDS PC (Marine Dental Services)
• Ann M Jackman, D.D.S.
• Brandon Joshua Jackson, D.D.S
• Dana Jackson, M.S.
• Keith Ryan Jackson, M.D.
• Kelly A Jackson, OTR/L
• Rebecca Sabrina Jackson, CRPA
• Sharon Jackson
• Starr Shalae Jackson

• Licensed Practical Nurse in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Licensed Practical Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.