MRS. STEPHANIE BRAZEAL JACKSON (NP) – Family Nurse Practitioner, NPI 1255512984
Family Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
9,652 NURSE PRACTITIONER in GA
Provider Addresses for MRS. STEPHANIE BRAZEAL JACKSON (NP)
711 TRESTLE RD
LOCUST GROVE, GA 302483465
Phone: (770) 914-5934
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 17 Open Payments records for all available years, with a total value of $460.
Total Amount is formed as General ($460) + Research ($0) + Ownership ($0) = $460.
Last reported payment date: 2024-11-13 • Largest payer in this snapshot: ConvaTec Inc. ($150).
Total Amount
$460
General + Research + Ownership
Payments
17
Total payment records
General Amount
$460
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-13
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ConvaTec Inc. | $150 |
| Corcept Therapeutics | $46 |
| Lilly USA, LLC | $32 |
| Xeris Pharmaceuticals, Inc. | $24 |
| SHIELD THERAPEUTICS INC | $23 |
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: 2008-10-14
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2023-10-31 (951 days ago).
Enrollment records
1
Earliest due date
2023-10-31
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20081014000048 | I | Nurse Practitioner | GA | 2023-10-31 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 30248)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | GA | |
| Nurse Practitioner | GA | |
| Internal Medicine | GA | |
| H O S P I T A L I S T | GA | |
| Internal Medicine | GA | |
| Internal Medicine | GA | |
| Hospitalist, Internal Medicine | IN | |
| N E U R O L O G Y | GA | |
| Nurse Practitioner | GA | |
| Hospitalist, Internal Medicine | GA |
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