NPIMap

Organization Active NPI

Jackson Hospital and Clinic, Inc.

Doing business as Jackson Clinic Multispecialty Prattville

  • Specialist
  • Prattville, AL
National Provider Identifier
1730727744
Registry record updated Mar 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
JACKSON HOSPITAL AND CLINIC, INC.
Doing business as
Jackson Clinic Multispecialty Prattville
Practice address
1840 E Main St
Prattville, AL 36066-5500
Phone
(334) 293-8736
Fax
(334) 293-8738
NPI assigned
Dec 20, 2019
Last updated
Mar 9, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2026

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

Authorized official

Name
Kelin Penney
Title
Executive Director
Phone
(334) 240-2335

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X Primary

Addresses

Primary practice location

1840 E Main St
Prattville, AL 36066-5500

Mailing address

1722 Pine St Ste 804
Montgomery, AL 36106-1108
Phone (334) 293-8736

Other names 1

  • Jackson Clinic Multispecialty Prattville Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tara.herring@jackson.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040414000971 AL Part B Supplier - Clinic/Group Practice 0547254153 Receives reassigned benefits from 247 practitioners
This NPI is an additional NPI on the enrollment

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
01D2179342Jackson Hospital & Clinic, Inc1840 E Main Street, Prattville, AL 36066Certificate of waiverFeb 19, 2028

National Provider Directory

National Provider Directory
Tax ID family
Jackson Primary Care72 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

1843 Glynwood Dr
Prattville, AL 36066

703 McQueen Smith Rd S
Prattville, AL 36066

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1576800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773014400000",
    "number": "1730727744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1722 PINE ST STE 804",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361061108",
            "telephone_number": "334-293-8736",
            "fax_number": "334-293-8738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1840 E MAIN ST",
            "city": "PRATTVILLE",
            "state": "AL",
            "postal_code": "360665500",
            "telephone_number": "334-293-8736",
            "fax_number": "334-293-8738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON HOSPITAL AND CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-20",
        "last_updated": "2026-03-09",
        "certification_date": "2026-03-09",
        "status": "A",
        "authorized_official_last_name": "PENNEY",
        "authorized_official_first_name": "KELIN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "334-240-2335"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tara.herring@jackson.org",
            "affiliation": "N",
            "address_1": "1840 E Main St",
            "city": "Prattville",
            "state": "AL",
            "country_code": "US",
            "postal_code": "360665500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Jackson Clinic Multispecialty Prattville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Prattville, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.