Kimmerly Jackson, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

353174 Issued in NY

Practice address

184 Barton St
Buffalo, NY 14213-1573

Phone

(716) 881-6191

Fax

(716) 881-6247

NPI assigned

Feb 1, 2024

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

Medicare fee-for-service enrollment

Enrolled in NY

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

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jericho Road Ministries, Inc.Group PAC ID 5597992933, 33 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kimmerly.jackson@jrchc.medentdirect.com

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.

• Jericho Road Ministries Inc.

  • Federally Qualified Health Center (FQHC)
  • Buffalo, NY
  • NPI 1972944080
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1706745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706745600000",
    "number": "1972366086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "184 BARTON ST",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142131573",
            "telephone_number": "716-881-6191",
            "fax_number": "716-881-6247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "184 BARTON ST",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142131573",
            "telephone_number": "716-881-6191",
            "fax_number": "716-881-6247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KIMMERLY",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-01",
        "last_updated": "2024-02-01",
        "certification_date": "2024-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "353174",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jordanei Rebecca Jackson
• Kathleen Jackson
• Kelley R Jackson, LPN
• Keyna Jackson
• Kimberly L Jackson, M.D.
• Laurletha Renay Jackson
• Melissa Rae Jackson
• Natasha Jackson
• Patricia Jackson, CRNA
• Roseanne Johnson Jackson

• Family Nurse Practitioner in Buffalo, NY
• Providers in Buffalo, NY by specialty
• Family Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.