Amy J Jackson, NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

71003983A Issued in IN

Practice address

2210 Jackson St
Anderson, IN 46016-4363

Phone

(765) 683-3118

NPI assigned

Jun 22, 2012

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

Other identifiers 2

Other names 1

• Amy J Kemp Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IN

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, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

St Vincent Anderson Regional Hospital IncGroup PAC ID 5890949622, 14 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ascension St Vincent Anderson Hospital, Anderson, IN, CCN 150088

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: amy.jackson.1@7598.direct.athenahealth.com
• Direct secure messaging: ajackson18@direct.iuhealth.org

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.

• St. Vincent Anderson Regional Hospital, Inc.

  • Psychiatry Physician
  • Anderson, IN
  • NPI 1659624179

  Psychiatric/Mental Health

  Medicare reassignment Care Compare group NPD
• Indiana University Health Ball Memorial Physicians, Inc.

  • Family Medicine Physician
  • Muncie, IN
  • NPI 1235455544

  Nurse Practitioner

  Medicare reassignment NPD
• St. Joseph Hospital & Health Center, Inc.

  • General Acute Care Hospital
  • Kokomo, IN
  • NPI 1780625442
  Medicare reassignment NPD
• St. Joseph Hospital & Health Center, Inc.

  • Psychiatry Physician
  • Kokomo, IN
  • NPI 1568799740

  Psychiatric/Mental Health

  NPD
• St. Vincent Anderson Regional Hospital, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Anderson, IN
  • NPI 1427480029
  NPD
• Major Hospital

  • General Acute Care Hospital
  • Shelbyville, IN
  • NPI 1174555692
  NPD (past)

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

• St. Vincent Anderson Regional Hospital, Inc.

  • General Acute Care Hospital
  • Anderson, IN
  • NPI 1679578850
  Care Compare affiliation

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

{
    "created_epoch": "1340323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701993600000",
    "number": "1972866085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2210 JACKSON ST",
            "city": "ANDERSON",
            "state": "IN",
            "postal_code": "460164363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2210 JACKSON ST",
            "city": "ANDERSON",
            "state": "IN",
            "postal_code": "460164363",
            "telephone_number": "765-683-3118"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2701 W North St Ste B",
            "address_purpose": "LOCATION",
            "city": "Muncie",
            "state": "IN",
            "postal_code": "473033415",
            "country_code": "US",
            "telephone_number": "765-281-6920",
            "fax_number": "765-747-4499",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1050 Reid Pkwy Ste 210",
            "address_purpose": "LOCATION",
            "city": "Richmond",
            "state": "IN",
            "postal_code": "473741160",
            "country_code": "US",
            "telephone_number": "765-939-7711",
            "fax_number": "765-939-1841",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1050 Reid Pkwy Ste 210",
            "address_purpose": "LOCATION",
            "city": "Richmond",
            "state": "IN",
            "postal_code": "473741160",
            "country_code": "US",
            "telephone_number": "765-939-7711",
            "fax_number": "765-939-1841",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "AMY",
        "middle_name": "J",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-22",
        "last_updated": "2023-12-08",
        "certification_date": "2023-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71003983A",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IN",
            "license": "71003983A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201072860",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000772417",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ajackson18@direct.iuhealth.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2701 W North St Ste B",
            "city": "Muncie",
            "state": "IN",
            "country_code": "US",
            "postal_code": "473033415",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "AMY",
            "last_name": "KEMP",
            "middle_name": "J",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Edward Irick, MD
• Alex Clayton Irwin, AG-ACNP
• Olivia Isaacs
• J M Holding Group Inc
• J. C. Hoover & Associates, Inc.
• Kristyne Jackson
• James E Moneyhun MD Medical Corporation
• James S Milligan MD Inc
• Kendra Rae Janney
• Julianne Jarrell, DEVELOPMENTAL THERAP

• Psychiatric/Mental Health Nurse Practitioner in Anderson, IN
• Providers in Anderson, IN by specialty
• Psychiatric/Mental Health Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2023; 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.