Stephanie D Jackson, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

RN210155 Issued in GA

Practice address

4605 Chestnut Oak St
Loganville, GA 30052-9408

Phone

(423) 227-8576

NPI assigned

Feb 1, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 14

Addresses

Other names 1

• Ms. Stephanie Denise Ray Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

Practice roles

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

• Amenity Nursing Care and Companion Services, LLC

  • In Home Supportive Care Agency
  • Loganville, GA
  • NPI 1225797822

  Home Health

  NPD Authorized official
• Solace Health and Wellness, LLC

  • Clinical Medical Laboratory
  • Loganville, GA
  • NPI 1043963838
  NPD Authorized official

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

{
    "created_epoch": "1643673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643673600000",
    "number": "1902559784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4605 CHESTNUT OAK ST",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300529408",
            "telephone_number": "423-227-8576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4605 CHESTNUT OAK ST",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300529408",
            "telephone_number": "423-227-8576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "STEPHANIE",
        "middle_name": "D",
        "name_prefix": "Mrs.",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-01",
        "last_updated": "2022-02-01",
        "certification_date": "2022-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Case Management",
            "state": "GA",
            "license": "RN210155",
            "primary": false
        },
        {
            "code": "163WE0900X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Enterostomal Therapy",
            "state": "GA",
            "license": "RN210155",
            "primary": false
        },
        {
            "code": "163WH0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Home Health",
            "state": "GA",
            "license": "RN",
            "primary": false
        },
        {
            "code": "163WC1500X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Community Health",
            "state": "GA",
            "license": "RN",
            "primary": false
        },
        {
            "code": "163WD0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Diabetes Educator",
            "state": "GA",
            "license": "RN210155",
            "primary": false
        },
        {
            "code": "163WA2000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Administrator",
            "state": "GA",
            "license": "RN210155",
            "primary": false
        },
        {
            "code": "163WH1000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Hospice",
            "state": "GA",
            "license": "RN",
            "primary": false
        },
        {
            "code": "163WI0500X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Infusion Therapy",
            "state": "GA",
            "license": "RN",
            "primary": false
        },
        {
            "code": "163WN1003X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Nutrition Support",
            "state": "GA",
            "license": "RN210155",
            "primary": false
        },
        {
            "code": "163WP0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Pain Management",
            "state": "GA",
            "license": "RN210155",
            "primary": false
        },
        {
            "code": "163WW0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Wound Care",
            "state": "GA",
            "license": "RN210155",
            "primary": false
        },
        {
            "code": "163WX0800X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Orthopedic",
            "state": "GA",
            "license": "RN210155",
            "primary": false
        },
        {
            "code": "163WX1500X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Ostomy Care",
            "state": "GA",
            "license": "RN210155",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "GA",
            "license": "RN210155",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STEPHANIE",
            "last_name": "RAY",
            "middle_name": "DENISE",
            "prefix": "MS.",
            "credential": "RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Keith Isaac
• Glenda Ivey, MASSAGE THERAPIST
• Keriana Edwina Jackson
• Latoria Nicole Jackson
• Michelle Jackson, APRN
• Rasid Jakupovic
• Emily Jannine Jamshedi, PA-C
• JD Preferred Home Care Agency LLC
• Michel Jeannot
• Jeffrey Bryce Carter DDS LLC

• Registered Nurse in Loganville, GA
• Providers in Loganville, GA by specialty
• Registered Nurse in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2022; 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.