ALISIA JACKSON APRN NPI 1104436146

NPI Information

  • NPI: 1104436146
  • Provider Name: ALISIA JACKSON, APRN
  • Classification: Nurse Practitioner - 363LF0000X
  • Specialization: Family
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 9204 TAYLORSVILLE RD STE 217
    LOUISVILLE, KY
    ZIP 40299
  • Phone: (502) 709-0430

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NPI Details

Alisia Jackson, APRN is a family nurse practitioner in Louisville, KY with 8 years of experience. Alisia Jackson, APRN NPI is 1104436146. 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:

9204 TAYLORSVILLE RD STE 217
LOUISVILLE, KY
ZIP 40299-789
Phone: (502) 709-0430

The NPI 1104436146 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 8/4/2020 and was last updated on 11/7/2023.

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
1363LF0000XNurse PractitionerFamily71011085AINDIANANo
2363LF0000XNurse PractitionerFamily3013490KENTUCKYYes
3363L00000XNurse Practitioner3013490KENTUCKYNo

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
17100720690MEDICAIDKENTUCKY

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: 11/21/2025

NPI Synchronization or Removal

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