Kevin Eric Glenn Jackson, MSN, APRN, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

APRN-NP231401 Issued in GA

Practice address

4038 Winder Hwy
Flowery Branch, GA 30542-3021

Phone

(678) 693-2364

Fax

(470) 778-2123

NPI assigned

May 29, 2023

Last updated

Oct 27, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kevin.jackson.2@21462.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Georgia Mountains Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Blue Ridge, GA
  • NPI 1538123666
  Medicare reassignment NPD
• Medlife Urgent Care LLC

  • Urgent Care Clinic/Center
  • McDonough, GA
  • NPI 1083249114
  Medicare reassignment NPD
• Medlife Healthcare LLC

  • Family Medicine Physician
  • Flowery Branch, GA
  • NPI 1558974709
  Medicare reassignment
• Georgia Mountains Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Chatsworth, GA
  • NPI 1144419813
  NPD
• Georgia Mountains Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • La Fayette, GA
  • NPI 1932991791
  NPD

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

{
    "created_epoch": "1685318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761523200000",
    "number": "1861185753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4038 WINDER HWY",
            "city": "FLOWERY BRANCH",
            "state": "GA",
            "postal_code": "305423021",
            "telephone_number": "678-693-2364",
            "fax_number": "470-778-2123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4038 WINDER HWY",
            "city": "FLOWERY BRANCH",
            "state": "GA",
            "postal_code": "305423021",
            "telephone_number": "678-693-2364",
            "fax_number": "470-778-2123"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "134 Ansley Dr Ste 700",
            "address_purpose": "LOCATION",
            "city": "Dahlonega",
            "state": "GA",
            "postal_code": "305331641",
            "country_code": "US",
            "telephone_number": "706-701-5001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KEVIN",
        "middle_name": "ERIC GLENN",
        "name_prefix": "Mr.",
        "credential": "MSN, APRN, FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-05-29",
        "last_updated": "2025-10-27",
        "certification_date": "2025-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "APRN-NP231401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shaneka Hutchinson
• Ideal Communications
• Illuminate Medical LLC
• Impact Counseling and Consulting, LLC
• Ingles Markets Inc (Ingles Pharmacy #412)
• Nerissa Jackson, PA-C
• David Jenkins, LAPC
• Ajita Joglekar, MD
• Gia Johnson, M.D.
• Jessica Hulsey Johnson, BCBA

• Family Nurse Practitioner in Flowery Branch, GA
• Providers in Flowery Branch, 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 Oct 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.