Kimberly Jackson FNP LLC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

336506 Issued in NY

Legal business name

KIMBERLY JACKSON FNP LLC

Doing business as

Kumuda Family Health Care

Practice address

31 Weber Hill Rd
Mahopac, NY 10541-1829

Phone

(914) 260-8087

Fax

(845) 767-5088

NPI assigned

Mar 29, 2016

Last updated

Mar 30, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kimberly A Jackson, FNP

Title

Owner/Provider

Phone

(914) 260-8087

Specialties & licenses 1

Addresses

Other names 1

• Kumuda Family Health Care Doing business as

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

{
    "created_epoch": "1459209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459296000000",
    "number": "1811350770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 WEBER HILL RD",
            "city": "MAHOPAC",
            "state": "NY",
            "postal_code": "105411829",
            "telephone_number": "914-260-8087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 WEBER HILL RD",
            "city": "MAHOPAC",
            "state": "NY",
            "postal_code": "105411829",
            "telephone_number": "914-260-8087",
            "fax_number": "845-767-5088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIMBERLY JACKSON FNP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-29",
        "last_updated": "2016-03-30",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "914-260-8087",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NY",
            "license": "336506",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kumuda Family Health Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Chloe Rome Kelleher, M.S.
• Jodi L Kennedy, D.C.
• Morgan Kennedy, LCSW
• Debra Kessler, MD
• Karen Marie Kid, MS
• Stacey King
• Elizabeth Ann Kirkman, RPH
• Carl Joseph Koenigsmann, M.D.
• Emma Korman
• Joan M. Krauss, LCSW

• Nurse Practitioner in Mahopac, NY
• Providers in Mahopac, NY by specialty
• Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2016; 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.