Individual
KELLI JOHNSON JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1566
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3940088
—
TN
01
—
4134928
BCBS & TNCARE SELECT #
TN
01
—
P00265658
RAILROAD MEDICARE PROV #
TN
Enumeration date
07/21/2006
Last updated
06/03/2019
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up