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General NPI Number Information
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NPI Number | 1649123639
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Entity Type | Individual
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Provider Name | KAILI ANNE JACKSON AGNP-C
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Gender | Female
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Dates
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Enumeration Date | 02/18/2026
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Last Update Date | 03/03/2026
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Provider Practice Location Address
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Address Line | 2546 BALLTOWN RD STE 200
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City | NISKAYUNA
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State | NY
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Zip | 12309-1079
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Country | US
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Telephone | 518-374-1444
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Fax | 518-374-0491
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Provider Business Mailing Address
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Address Line | 6 WELLNESS WAY STE 201
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City | LATHAM
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State | NY
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Zip | 12110-2156
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Country | US
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Telephone | 518-782-3700
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Fax | 518-782-3799
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | F312706-01
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License Number State | NY
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