DR. JACQUELINE KAY JACKSON M.D. NPI 1104157643

NPI Information

NPI: 1104157643
Provider Name: DR. JACQUELINE KAY JACKSON, M.D.
Classification: Family Medicine - 207QA0505X
Entity Type: Individual

Specialization: Adult Medicine

PECOS Registration: Yes

Address:
1621 NE WALDO RD
GAINESVILLE, FL
ZIP 32609
Phone: (352) 264-8272
Get Directions

DR. Jacqueline Kay Jackson, M.D. is an adult medicine family medicine in Gainesville, FL. The provider is the National Uniform Claim Committee (NUCC) recommends code 207QA0505X not be used. Choose a more appropriate code. DR. Jacqueline Kay Jackson, M.D. NPI is 1104157643. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1621 NE WALDO RD
GAINESVILLE, FL
ZIP 32609-900
Phone: (352) 264-8272
Fax: (352) 264-8304

The NPI 1104157643 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 1/22/2010 and was last updated on 2/25/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207QA0505X	Family Medicine	Adult Medicine	ME 0058078	FLORIDA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	010829000	MEDICAID	FLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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