Nicole Stanley Jackson, NP-C is a medicare enrolled "Nurse Practitioner - Family" in Tennille, Georgia. Her current practice location is
116 Smith St, Tennille, Georgia. You can reach out to her office (for appointments etc.) via phone at
(478) 552-1620.
Nicole Stanley Jackson is licensed to practice in Georgia (license number RN143548) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1659787034.
Provider's Profile
| Full Name | Nicole Stanley Jackson |
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| Gender | Female |
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| Speciality | Nurse Practitioner - Family |
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| Location | 116 Smith St, Tennille, Georgia |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1659787034
- Provider Enumeration Date: 07/07/2014
- Last Update Date: 10/24/2023
Medicare PECOS Information:
- PECOS PAC ID: 1153649165
- Enrollment ID: I20150422001744
Medical Identifiers
Medical identifiers for Nicole Stanley Jackson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1659787034 | NPI | - | NPPES |
| F0414179 | Other | GA | AMERICAN ACADEMY OF NURSE PRACTITIONERS |
| RN143548 | Other | GA | GEORGIA SECRETARY OF STATE |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 363LF0000X | Nurse Practitioner - Family | RN143548 (Georgia) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Nicole Stanley Jackson allows following entities to bill medicare on her behalf.
| Entity Name | Community Health Care Systems, Inc. |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1932150422
PECOS PAC ID: 5890783179
Enrollment ID: O20040505000153 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Nicole Stanley Jackson is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Nicole Stanley Jackson, NP-C
Po Box 371,
Wrightsville, GA 31096-0371
Ph: (478) 864-3448 | Nicole Stanley Jackson, NP-C
116 Smith St,
Tennille, GA 31089-1465
Ph: (478) 552-1620 |
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