NPIMap

Individual provider Active NPI

Kimberly Jackson, DNP, FNP-BC

  • Family Nurse Practitioner
  • Denver, NC
National Provider Identifier
1871012682
Registry record updated Jul 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
5009861 Issued in NC
Practice address
4764 N NC 16 Business Hwy
Denver, NC 28037-7915
Phone
(980) 222-7004
NPI assigned
Sep 12, 2017
Last updated
Jul 22, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 5009861 NC Primary

Addresses

Primary practice location

4764 N NC 16 Business Hwy
Denver, NC 28037-7915

Mailing address

4764 N NC 16 Business Hwy
Denver, NC 28037-7915
Phone (980) 222-7004

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180118001998 NC Practitioner - Nurse Practitioner 9032478169 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wake Forest Health Network LLCGroup PAC ID 4183538895, 276 clinicians

Practice addresses (Care Compare)

2359 Springs Rd NE
Hickory, NC 28601-3067
Phone (828) 256-9853

4764 N NC 16 Business Hwy
Denver, NC 28037-7915
Phone (980) 222-7004

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Forest Health Network, LLC CurrentSince Dec 4, 2017 Accepting new patients
Wake Forest Health Network LLC Current Accepting new patients
Wake Forest Health Network LLC CurrentSince Dec 4, 2017 Accepting new patients
Jackson Family Medicine and Wellness Center Inc. Family CurrentSince Sep 29, 2025 Accepting new patients

Locations

4764 N NC 16 Business Hwy
Denver, NC 28037
Phone (704) 320-5347

2359 Springs Rd NE
Hickory, NC 28601
Phone (828) 210-2803

1701 Westchester Dr
Ste 850
High Point, NC 27262
Phone (336) 802-2400

905 Phillips Ave
High Point, NC 27262
Phone (336) 802-2040

Interoperability endpoints

  • Direct secure messaging: kimberly.jackson@1002201735430148.direct.elationemr.com
  • Direct secure messaging: kjackson2753572@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 4

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.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1505174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784678400000",
    "number": "1871012682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4764 N NC 16 BUSINESS HWY",
            "city": "DENVER",
            "state": "NC",
            "postal_code": "280377915",
            "telephone_number": "980-222-7004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4764 N NC 16 BUSINESS HWY",
            "city": "DENVER",
            "state": "NC",
            "postal_code": "280377915",
            "telephone_number": "980-222-7004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KIMBERLY",
        "credential": "DNP, FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-12",
        "last_updated": "2026-07-22",
        "certification_date": "2026-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5009861",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Denver, NC

Sources for this page

Verify at the official NPI Registry.