Kalyse Danae Jackson, RN, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95014247 Issued in CA

Practice address

1405 W Rancho Vista Blvd
Palmdale, CA 93551-3968

Phone

(373) 783-9423

NPI assigned

Feb 2, 2020

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

Other names 1

• Calice Danae Jackson Former name

Medicare fee-for-service enrollment

Enrolled in CA

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 1

Specialty

Nurse Practitioner

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

County of Los AngelesGroup PAC ID 1850296534, 395 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner, Registered Nurse

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.

• County of Los Angeles

  • General Acute Care Hospital
  • Torrance, CA
  • NPI 1851363188
  Medicare reassignment Care Compare group NPD
• County of Los Angeles

  • Clinic/Center
  • Los Angeles, CA
  • NPI 1295407401
  NPD
• County of Los Angeles

  • Clinic/Center
  • Palmdale, CA
  • NPI 1730191628
  NPD

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

{
    "created_epoch": "1580601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584576000000",
    "number": "1801427448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43943 CATSUE PL",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935365566",
            "telephone_number": "661-400-7095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1405 W RANCHO VISTA BLVD",
            "city": "PALMDALE",
            "state": "CA",
            "postal_code": "935513968",
            "telephone_number": "373-783-9423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KALYSE",
        "middle_name": "DANAE",
        "name_prefix": "Mrs.",
        "credential": "RN, NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-02",
        "last_updated": "2020-03-19",
        "certification_date": "2020-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WX0003X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Obstetric, Inpatient",
            "state": "CA",
            "license": "837226",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95014247",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CALICE",
            "last_name": "JACKSON",
            "middle_name": "DANAE",
            "credential": "RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Richard Alan Iosue, O.D.
• Ivan Banner Boarding Care
• Ivy Elite Care LLC
• J. Yang Chiropractic Corp
• Judy Eva Jackson, PT
• Taiesha Jackson
• David Jaco
• Monica Eman Jacobs, REGISTERED NURSE
• Sarah Jacobs
• Jades Heart & Home Care LLC

• Family Nurse Practitioner in Palmdale, CA
• Providers in Palmdale, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2020; 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.