Nicole S Jackson, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN277697 Issued in GA

Practice address

4 Skidaway Village Walk Ste B
Savannah, GA 31411-2962

Phone

(912) 598-6312

Fax

(912) 335-7897

NPI assigned

Sep 24, 2007

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 identifiers 1

Other names 1

• Mrs. Nicole Stephanie Jackson Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Networks

• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H9678

Interoperability endpoints

• Direct secure messaging: nicole.jackson.1@22339.direct.athenahealth.com

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

{
    "created_epoch": "1190592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736985600000",
    "number": "1831385848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 JOHNNY MERCER BLVD",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314102102",
            "telephone_number": "912-897-3220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 SKIDAWAY VILLAGE WALK STE B",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314112962",
            "telephone_number": "912-598-6312",
            "fax_number": "912-335-7897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "NICOLE",
        "middle_name": "S",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-24",
        "last_updated": "2025-01-16",
        "certification_date": "2025-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN277697",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NY",
            "license": "F334631 1",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02733026",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "JACKSON",
            "middle_name": "STEPHANIE",
            "prefix": "MRS.",
            "credential": "RN MSN FNP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Lester G. Jackson, D.D.S.
• Lori Jane Jackson, M.S. CCC-SLP
• Lorna C. Jackson, D.D.S.
• Marcella Jackson, CNA/MAA
• Michael Joseph Jackson, MD
• Nkenge Ayeola Jackson, M.D.
• Paige B Jackson, AA
• Shatara Jackson, LCSW
• Teliyah Nevaeh Jackson
• Trinity Jackson

• Family Nurse Practitioner in Savannah, GA
• Providers in Savannah, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2025; 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.