Maureen Khadija Jackson, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

28634 Issued in NC

Practice address

1510 Hogan CT
Concord, NC 28025-0240

Phone

(716) 228-3266

NPI assigned

Feb 14, 2013

Last updated

Feb 14, 2013By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1360800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1360800000000",
    "number": "1932448743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1510 HOGAN CT",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280250240",
            "telephone_number": "716-228-3266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1510 HOGAN CT",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280250240",
            "telephone_number": "716-228-3266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MAUREEN",
        "middle_name": "KHADIJA",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-02-14",
        "last_updated": "2013-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NC",
            "license": "28634",
            "primary": true
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "311952",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• J Harmoni Transport LLC
• J Little DDS MSD PLLC (Raceway Orthodontics)
• Brian K. Jackson, LCSW, LCAS
• Jazmyn Janae Jackson
• Latasha Monique Jackson, LMBT
• Princess Jackson
• Sandra Denise Jackson, LCSWA
• Brandie Nicole Jacobs, APRN FNP-C
• Devin Jacobs
• Heather Woods Jacobs, R.N., B.S.N.

• Licensed Practical Nurse in Concord, NC
• Providers in Concord, NC by specialty
• Licensed Practical Nurse in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2013; 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.