KIMBERLY DIANNE BILLIE JACKSON AGNP-C NPI 1588293278

NPI Information

NPI: 1588293278
Provider Name: KIMBERLY DIANNE BILLIE JACKSON, AGNP-C
Classification: Clinic/Center - 261QC1500X
Entity Type: Individual

Specialization: Community Health

PECOS Registration: Yes

Address:
940 MORNINGSIDE DR
SUMTER, SC
ZIP 29153
Phone: (914) 359-7442
Get Directions

Kimberly Dianne Billie Jackson, AGNP-C is a community health clinic center in Sumter, SC with 5 years of experience. Kimberly Dianne Billie Jackson, AGNP-C NPI is 1588293278. 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:

940 MORNINGSIDE DR
SUMTER, SC
ZIP 29153-724
Phone: (914) 359-7442
Fax: (803) 883-4087

The NPI 1588293278 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 4/4/2020 and was last updated on 12/27/2021.

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	291U00000X	Clinical Medical Laboratory		23707	SOUTH CAROLINA	No
2	261QC1500X	Clinic/Center	Community Health	APN.23707	SOUTH CAROLINA	Yes
3	363LA2200X	Nurse Practitioner	Adult Health	APN.23707	SOUTH CAROLINA	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	AG01200075	OTHER		AANP CERTIFICATION NUMBER
2	AG01200075	OTHER		AMERICAN ASSOCIATION OF NURSE PRACTITIONERS CERTIFYING BOARD

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: 5/5/2024

NPI Synchronization or Removal

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