KELLEY J JACKSON WHNP NPI 1558044644

NPI Information

  • NPI: 1558044644
  • Provider Name: KELLEY J JACKSON, WHNP
  • Classification: Nurse Practitioner - 363LW0102X
  • Specialization: Women's Health
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 1095 MARSHALL WAY
    PLACERVILLE, CA
    ZIP 95667
  • Phone: (530) 344-5470

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NPI Details

Kelley J Jackson, WHNP is a women's health nurse practitioner in Placerville, CA with 3 years of experience. Kelley J Jackson, WHNP NPI is 1558044644. The provider is registered as an individual entity type and is a single specialty group.

The NPPES NPI record indicates the provider is a female.

Education
Medical School: UNIVERSITY OF CINCINNATI COLLEGE OF MEDICINE
Graduation Year:2023

The provider's business location address is:

1095 MARSHALL WAY
PLACERVILLE, CA
ZIP 95667-722
Phone: (530) 344-5470

The NPI 1558044644 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 8/8/2023 and was last updated on 8/8/2023.

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
1363LW0102XNurse PractitionerWomen's Health95026533CALIFORNIAYes

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

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