Active NPI
Shelita Renee Jackson
- Home Health Agency
- Louisville, KY
National Provider Identifier
1851281851
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- License
- 50203414
- Practice address
- 2420 Avalon Dr
Louisville, KY 40216-1738 - Phone
- (502) 644-0002
- Fax
- (502) 644-0002
- NPI assigned
- Jul 9, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | 50203414 | KY | Primary |
Addresses
Primary practice location
2420 Avalon Dr
Louisville, KY 40216-1738
Mailing address
2420 Avalon Dr
Louisville, KY 40216-1738
Phone (502) 644-0002
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50203414 | KY | MD | Home Health Agency |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1752019200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1752019200000",
"number": "1851281851",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2420 AVALON DR",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402161738",
"telephone_number": "502-644-0002"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2420 AVALON DR",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402161738",
"telephone_number": "502-644-0002",
"fax_number": "502-644-0002"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "SHELITA",
"middle_name": "RENEE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-07-09",
"last_updated": "2025-07-09",
"certification_date": "2025-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": "KY",
"license": "50203414",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Louisville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.