Healthcare Provider Details

I. General information

NPI: 1487332284
Provider Name (Legal Business Name): JONI MELINDA JACKSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JONI JACKSON CHARBONNEAU PMHNP

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SC HOUSE CALLS, INC. 111 DOCTORS CIR.
COLUMBIA SC
29203
US

IV. Provider business mailing address

SC HOUSE CALLS, INC. 111 DOCTORS CIR.
COLUMBIA SC
29203
US

V. Phone/Fax

Practice location:
  • Phone: 800-491-0909
  • Fax:
Mailing address:
  • Phone: 800-491-0909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberGAA-NP001470
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberGAA-NP001470
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: