ALISIA JACKSON APRN NPI 1104436146

NPI Information

NPI: 1104436146
Provider Name: ALISIA JACKSON, APRN
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

PECOS Registration: Yes

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

Alisia Jackson, APRN is a family nurse practitioner in Louisville, KY. 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
1	363LF0000X	Nurse Practitioner	Family	71011085A	INDIANA	No
2	363LF0000X	Nurse Practitioner	Family	3013490	KENTUCKY	Yes
3	363L00000X	Nurse Practitioner		3013490	KENTUCKY	No

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	7100720690	MEDICAID	KENTUCKY

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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