NPIMap

Individual provider Active NPI

Paula Deaun Jackson, CRNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Philadelphia, PA
National Provider Identifier
1801877907
Registry record updated Dec 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
SP030377 Issued in PA
Practice address
160 E Erie Ave Ste 3311
Philadelphia, PA 19134-1011
Phone
(215) 427-3803
Fax
(215) 492-8119
NPI assigned
Nov 7, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X SP030377 PA Primary
Community Health Nurse Practitioner 363LC1500X 26NJ00025500 NJ
Nurse Practitioner 363L00000X TP004745D PA

Addresses

Primary practice location

160 E Erie Ave Ste 3311
Philadelphia, PA 19134-1011

Mailing address

PO Box 13579
Reading, PA 19612-3579
Phone (484) 628-1324

Other practice location 1

1015 Chestnut St Ste 1520
Philadelphia, PA 19107-4315
Phone (855) 675-4010

Other practice location 2

1511 Carpenter St
Philadelphia, PA 19146-2110
Phone (215) 923-2690

Other names 1

  • Ms. Paula Deaun Jackson Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111227000017 PA Practitioner - Nurse Practitioner 9537106240 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
26NJ00025500NJMDCommunity Health Nurse Practitioner
SP030377PAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
STC Pediatrics LLC CurrentSince Dec 1, 2019 Accepting new patients
STC Pediatrics LLC Current Accepting new patients
STC Pediatrics LLC CurrentSince Dec 1, 2019 Accepting new patients
STC Pediatrics LLC Past Accepting new patients
Tracey Jones, M.D., P.C. PastSince Feb 11, 2012 Accepting new patients

Locations

153 Brodhead Rd
Bethlehem, PA 18017
Phone (484) 526-3200

160 E Erie Ave
Ste 3311
Philadelphia, PA 19134
Phone (215) 427-3803

160 E Erie Ave
Philadelphia, PA 19134
Phone (215) 427-4067

300 E Hunting Park Ave
Philadelphia, PA 19124
Phone (215) 427-8363

Ownership & related parties

All facility ownership & control disclosures 12

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Greater Philadelphia Health Action IncPhiladelphia, PA, CCN 391801 Federally qualified health center Corporate Officer Dec 16, 2014
Greater Philadelphia Health Action IncPhiladelphia, PA, CCN 391820 Federally qualified health center Corporate Officer Oct 13, 2014
Greater Philadelphia Health Action IncPhiladelphia, PA, CCN 391802 Federally qualified health center Corporate Officer
Corporate Director		 Mar 1, 1993
Mar 1, 1993
Greater Philadelphia Health Action IncPhiladelphia, PA, CCN 391867 Federally qualified health center Corporate Officer Jun 23, 2008
Gpha - Chinatown Medical ServicesPhiladelphia, PA, CCN 391961 Federally qualified health center Corporate Director Mar 10, 2015
Greater Philadelphia Health Action IncPhiladelphia, PA, CCN 391935 Federally qualified health center Corporate Director Mar 1, 1993
Greater Philadelphia Health Action Inc-Dental & Behavioral HealthcarePhiladelphia, PA, CCN 391029 Federally qualified health center Corporate Officer Mar 1, 1993
Gpha- Inc Medical Suite at Temples Dental SchoolPhiladelphia, PA, CCN 391073 Federally qualified health center Corporate Officer Mar 1, 1993
Greater Philadelphia Health Action IncPhiladelphia, PA, CCN 391079 Federally qualified health center Corporate Officer Mar 1, 1993
Gpha - Spectrum Behavioral ServicesSpringfield, PA, CCN 391098 Federally qualified health center Corporate Officer Mar 1, 1993
Greater Philadelphia Health Action IncPhiladelphia, PA, CCN 391123 Federally qualified health center Corporate Officer Mar 1, 1993
Gpha-Cristo Rey Health SuitePhiladelphia, PA, CCN D31057 Federally qualified health center Corporate Director Jun 23, 2008

Owned or controlled facilities with NPI records 13

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 13

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1131321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765756800000",
    "number": "1801877907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13579",
            "city": "READING",
            "state": "PA",
            "postal_code": "196123579",
            "telephone_number": "484-628-1324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 E ERIE AVE STE 3311",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191341011",
            "telephone_number": "215-427-3803",
            "fax_number": "215-492-8119"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1015 Chestnut St Ste 1520",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191074315",
            "country_code": "US",
            "telephone_number": "855-675-4010",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1511 Carpenter St",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191462110",
            "country_code": "US",
            "telephone_number": "215-923-2690",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "PAULA",
        "middle_name": "DEAUN",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-07",
        "last_updated": "2025-12-15",
        "certification_date": "2025-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "PA",
            "license": "SP030377",
            "primary": true
        },
        {
            "code": "363LC1500X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Community Health",
            "state": "NJ",
            "license": "26NJ00025500",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "TP004745D",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PAULA",
            "last_name": "JACKSON",
            "middle_name": "DEAUN",
            "prefix": "MS.",
            "credential": "PMHNP, CRNP, LNC",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.