Linda D Jackson, RN,MSN,NP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

CO76267 Issued in CO

Practice address

1925 E Orman Ave
Suite a 535
Pueblo, CO 81004-3537

Phone

(719) 564-0450

Fax

(719) 564-1659

NPI assigned

Sep 24, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CO

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, Nurse Practitioner, Registered Nurse

State licenses

Practice roles

Locations

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.

• Heritage Internal Medicine, PC

  • Internal Medicine Physician
  • Pueblo, CO
  • NPI 1669681581

  CO

  Medicare reassignment NPD
• Hospitalists of Pueblo

  • Specialist
  • Pueblo, CO
  • NPI 1922016393
  NPD (past)

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

{
    "created_epoch": "1159056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386288000000",
    "number": "1902906548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "694 S CALAVERAS DR",
            "city": "PUEBLO WEST",
            "state": "CO",
            "postal_code": "810071942",
            "telephone_number": "719-564-0450",
            "fax_number": "719-564-1659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1925 E ORMAN AVE",
            "address_2": "SUITE A 535",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810043537",
            "telephone_number": "719-564-0450",
            "fax_number": "719-564-1659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "LINDA",
        "middle_name": "D",
        "credential": "RN,MSN,NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-24",
        "last_updated": "2013-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CO",
            "license": "CO76267",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38330750",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carla Jean Jackson-Howard, ACNP-BC
• Brittany Oreon Jackson, MBA
• Jaelyn Davette Jackson
• John Mark Jackson
• Kimberley Evelyn Jackson, D.O.
• Kandus Jacobs
• Susanna Jacobs, DPM
• Lisa Jagger, BSW
• William J. Jagger, D.D.S.
• Karan Jaggi, MD

• All providers in Pueblo, CO
• Nurse Practitioner in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2013; 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.