NICOLE JACKSON (FNP, PMHNP) – Psychiatric/Mental Health Nurse Practitioner, NPI 1366974628

NICOLE JACKSON (FNP, PMHNP) is a healthcare provider. based in Dover, Delaware. specializing in NURSE PRACTITIONER. They hold the professional credentials FNP, PMHNP. They hold a License No. LG0001029 (DE). The NPI Number for NICOLE JACKSON (FNP, PMHNP) is 1366974628

Main info

Female
9 Years Of Experience
Accepts Medicare Assignment
Name
NICOLE JACKSON (FNP, PMHNP)
NPI
1366974628
Phone
(302) 652-2455
Address
1020 FORREST AVE
Enumeration Date
28 March 2017
Last Update Date
20 February 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3022649436
Graduation Year
2017 (9 years ago)
PAC ID
7113294034
Group Practice PAC ID
1355742735
Professional Enrollment ID
I20170525000568
Address ID
DE199044153DO1001XSTXX432
Telehealth
Yes
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience56
Completeness75
Years active:9State licenses:2Digital endpointsOther names

1,273 NURSE PRACTITIONER in DE

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Provider Addresses for NICOLE JACKSON (FNP, PMHNP)

  • Forrest Avenue, Woodstock Court, Dover, Kent County, Delaware, 19904, United States

    DOVER, DE 19904

    Phone: (302) 652-2455

    Fax: (302) 322-6251

    Type: Mailing

  • 200 BANNING ST STE 260

    DOVER, DE 199043489

    Phone: (302) 224-1400

    Fax: (302) 224-1402

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 20 Open Payments records for all available years, with a total value of $427.

Total Amount is formed as General ($427) + Research ($0) + Ownership ($0) = $427.

Last reported payment date: 2024-08-23 • Largest payer in this snapshot: Teva Pharmaceuticals USA, Inc. ($129).

Total Amount

$427

General + Research + Ownership

Payments

20

Total payment records

General Amount

$427

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-08-23

Latest reported date

View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2017-05-25

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20170525000568INurse PractitionerDETBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99214Established patient office or other outpatient visit, 30-39 minutes17936$0
90833Psychotherapy with evaluation and management visit, 30 minutes9727$0
View full utilization report →

Insurance plans in this area (ZIP 19904)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 1355742735View full group profile
NameSpecialtyState
Nurse PractitionerDE
Clinical Social WorkerDE

Reviews

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Frequently asked questions

How is NICOLE JACKSON (FNP, PMHNP) identified in CMS data?
CMS-hosted NPPES data lists NICOLE JACKSON (FNP, PMHNP) with NPI 1366974628.
Can I rely on NICOLE JACKSON (FNP, PMHNP) being an active provider?
As of the registry snapshot, NICOLE JACKSON (FNP, PMHNP) is marked active.
What is NICOLE JACKSON (FNP, PMHNP) best known for clinically?
Directory data describes NICOLE JACKSON (FNP, PMHNP) with Psychiatric/Mental Health Nurse Practitioner. Clinical services aligned with this taxonomy classification.
Where should I expect NICOLE JACKSON (FNP, PMHNP) on a map?
Expect Dover, Delaware as a primary anchor for NICOLE JACKSON (FNP, PMHNP) unless the record lists multiple sites.
Is the information about NICOLE JACKSON (FNP, PMHNP) up to date?
Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."

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