MS. BERTHA ADELE JACKSON CRNP NPI 1598078404

NPI Information

NPI: 1598078404
Provider Name: MS. BERTHA ADELE JACKSON, CRNP
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

PECOS Registration: Yes

Address:
5501 OLD YORK RD
PALEY FIRST FLOOR
PHILADELPHIA, PA
ZIP 19141
Phone: (215) 456-6532
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MS. Bertha Adele Jackson, CRNP is a family nurse practitioner in Philadelphia, PA. MS. Bertha Adele Jackson, CRNP NPI is 1598078404. 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:

5501 OLD YORK RD
PALEY FIRST FLOOR
PHILADELPHIA, PA
ZIP 19141-018
Phone: (215) 456-6532
Fax: (215) 456-7375

The NPI 1598078404 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 7/20/2010 and was last updated on 7/20/2010.

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	SP010712	PENNSYLVANIA	Yes

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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