KELLONTREIA LAPORCHE JACKSON (A-GNP-C) – Nurse Practitioner, NPI 1619685534
Nurse Practitioner
Main info
Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
9,658 NURSE PRACTITIONER in GA
Provider Addresses for KELLONTREIA LAPORCHE JACKSON (A-GNP-C)
3692 Tullamore Ln
Snellville, GA 300397046
Phone: (706) 573-1023
Type: Location
41800 W 11 MILE RD STE 109
NOVI, MI 483751818
Phone: (248) 660-1220
Type: Mailing
4196 HIGHWAY 62 412 STE A
HARDY, AR 725428002
Phone:
Type: Mailing
37 341 BYP
HAWKINSVILLE, GA 310364839
Phone: (478) 845-4842
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
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: 2025-11-13
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 6 Medicare enrollment records; no due dates published yet.
Enrollment records
6
Earliest due date
Not assigned (TBD)
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 |
|---|---|---|---|---|
| I20221111000944 | I | Nurse Practitioner | GA | TBD |
| I20241023003825 | I | Nurse Practitioner | CO | TBD |
| I20250424002817 | I | Nurse Practitioner | TX | TBD |
| I20250425001776 | I | Nurse Practitioner | IA | TBD |
| I20250522001651 | I | Nurse Practitioner | TN | TBD |
| I20251113001854 | I | Nurse Practitioner | MI | TBD |
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.
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 30039)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Geriatric Medicine, Geriatric Medicine, Internal Medicine | CT | |
| Nurse Practitioner | NJ | |
| General Practice, Geriatric Medicine, Internal Medicine | NJ | |
| Emergency Medicine | TX | |
| Hospitalist, Family Practice | KY | |
| Nurse Practitioner | AL |
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