Healthcare Provider Details

I. General information

NPI: 1871012682
Provider Name (Legal Business Name): KIMBERLY JACKSON DNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2017
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4764 N NC 16 BUSINESS HWY
DENVER NC
28037-7915
US

IV. Provider business mailing address

4764 N NC 16 BUSINESS HWY
DENVER NC
28037-7915
US

V. Phone/Fax

Practice location:
  • Phone: 980-222-7004
  • Fax:
Mailing address:
  • Phone: 980-222-7004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5009861
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: