Active NPI
Mary Katherine Jackson, FNP
- Family Nurse Practitioner
- Jacksonville, FL
National Provider Identifier
1780664854
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 420469
- Practice address
- 2080 Child St
Jacksonville, FL 32214-5005 - Phone
- (904) 542-7516
- Fax
- (904) 542-7913
- NPI assigned
- Jan 17, 2006
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 420469 | CA | Primary |
Addresses
Primary practice location
2080 Child St
Jacksonville, FL 32214-5005
Mailing address
2521 Sunny Creek Dr
Orange Park, FL 32003-4970
Phone (904) 542-7516
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)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 420469 | CA | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137456000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1780664854",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2521 SUNNY CREEK DR",
"city": "ORANGE PARK",
"state": "FL",
"postal_code": "320034970",
"telephone_number": "904-542-7516",
"fax_number": "904-542-7913"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2080 CHILD ST",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322145005",
"telephone_number": "904-542-7516",
"fax_number": "904-542-7913"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "MARY",
"middle_name": "KATHERINE",
"name_prefix": "Ms.",
"credential": "FNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-01-17",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "CA",
"license": "420469",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.