Naomi Namrota Jackson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-12831 Issued in NC

Practice address

2909 Market St
Wilmington, NC 28403-1221

Phone

(910) 795-2118

NPI assigned

Dec 5, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/13974/brand/1/csg/1/fhir/r4

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

{
    "created_epoch": "1670198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684108800000",
    "number": "1730899352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1630 BARCLAY POINTE BLVD APT 9201",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284121107",
            "telephone_number": "731-535-1629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2909 MARKET ST",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284031221",
            "telephone_number": "910-795-2118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "NAOMI",
        "middle_name": "NAMROTA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-12-05",
        "last_updated": "2023-05-15",
        "certification_date": "2023-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "NC",
            "license": "0010-12831",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-12831",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joann Kate Jackson, PAC
• Jonathan Floyd Jackson, O.D.
• Joseph Alan Jackson, LCMHCA
• Latoya Jackson, MS,QP
• Mary Louise Jackson, NP
• P Brian Jackson, OD
• Rebecca Grace Jackson, MSW, LCSW
• Tiffany L Jackson, O.D.
• Woody H Jackson, MD
• Jacob R. Long, DDS, PLLC

• Physician Assistant in Wilmington, NC
• Providers in Wilmington, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.