Kimberly Moniwue Gilmore Jackson, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

2785861 Issued in NY

Practice address

5285 Lewiston Rd
Lewiston, NY 14092-1942

Phone

(716) 298-2900

Fax

(716) 298-3815

NPI assigned

Dec 8, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1291766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1291766400000",
    "number": "1811290141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8521 PORTER RD APT 108",
            "city": "NIAGARA FALLS",
            "state": "NY",
            "postal_code": "143041631",
            "telephone_number": "716-297-6075",
            "fax_number": "716-298-3815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5285 LEWISTON RD",
            "city": "LEWISTON",
            "state": "NY",
            "postal_code": "140921942",
            "telephone_number": "716-298-2900",
            "fax_number": "716-298-3815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILMORE JACKSON",
        "first_name": "KIMBERLY",
        "middle_name": "MONIWUE",
        "name_prefix": "Ms.",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-12-08",
        "last_updated": "2010-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "2785861",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Leonard Frandina, MD
• Elizabeth Galland, M.S.ED. CCC/L-SP
• Lewis Charles Garlow, L.M.T.
• Gerald Pucillo Applied Behavior Analyst, P.C.
• Thomas R Gerbasi, M.D.
• Gina Godwin, OTR/L
• Craig Gonzales Sr.
• William T Goode I, PA-C
• Nakeata Graham
• Emily Katherine Green, RN

• All providers in Lewiston, NY
• Licensed Practical Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.