MEDICARE: JACKSON FAMILY MEDICINE AND WELLNESS CENTER INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1780561118
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACKSON FAMILY MEDICINE AND WELLNESS CENTER INC.

Provider Business Mailing Address
First Line	:	4764 N NC 16 BUSINESS HWY
Second Line	:
City	:	DENVER
State	:	NC
Zip	:	28037-7915
Country	:	US
Telephone Number	:	980-222-7004
Fax Number	:	980-375-1173

Provider Business Practice Location Address
First Line	:	4764 N NC 16 BUSINESS HWY
Second Line	:
City	:	DENVER
State	:	NC
Zip	:	28037-7915
Country	:	US
Telephone Number	:	980-222-7004
Fax Number	:	980-375-1173

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KIMBERLY JACKSON
Credential	:	DNP, FNP-BC
Telephone Number	:	704-320-5347

Provider Enumeration Date	:	08/18/2025
Last Update Date	:	02/15/2026

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