Tracy Jackson, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

041.392089 Issued in IL

Practice address

4101 W Iles Ave
Springfield, IL 62711-7051

Phone

(217) 993-7085

NPI assigned

Jun 23, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1624406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624406400000",
    "number": "1831768852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5964 MILLS BOTTOM RD",
            "city": "SHIPMAN",
            "state": "IL",
            "postal_code": "626856729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4101 W ILES AVE",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627117051",
            "telephone_number": "217-993-7085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "TRACY",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-23",
        "last_updated": "2021-06-23",
        "certification_date": "2021-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041.392089",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tracy.jackson@lssliving.org",
            "affiliation": "N",
            "address_1": "4101 W Iles Ave",
            "city": "Springfield",
            "state": "IL",
            "country_code": "US",
            "postal_code": "627117051",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jill Christine Jackson, MA, LCPC
• Karen Jackson
• Robert Leon Jackson, PH.D.
• Ruth V Jackson, NNP
• Shawnee Jackson, RBT
• Waylon Colby Jackson, CRNA, CPNP-AC, CCRN
• Ann Jacob
• Benjamin Jacobs, RBT
• Sarah Ann Jacobs, DDS
• Adrienne L Jacobson, M.A., B.C.B.A.

• Registered Nurse in Springfield, IL
• Providers in Springfield, IL by specialty
• Registered Nurse in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2021; 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.