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DR. COLLEEN M JACKSON EDD
NPI 1043002553
Licensed Practical Nurse in Syracuse, NY

Active since May 20, 2025
153 WOODBURY AVE, SYRACUSE, NY 13206(315) 254-4884 Get Directions Write a Review

NPPES record last updated: May 20, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Dr. Colleen M Jackson Edd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. COLLEEN M JACKSON EDD (NPI 1043002553) is an individual licensed practical nurse in Syracuse, New York, licensed in New York (199332) and active in the NPI registry since May 2025. She maintains a secondary practice location in Syracuse.

NPPES Registry Identity

NPI1043002553
Entity TypeIndividualFemale
Primary Taxonomy164W00000X
Provider Legal NameDR. COLLEEN M JACKSONCredential: EDD
Location Address153 WOODBURY AVESyracuse, NY 13206-1935
Mailing Address153 Woodbury AveSyracuse, NY 13206-1935 · (315) 254-4884
Phone(315) 254-4884
Sole ProprietorYes
Enumeration DateMay 20, 2025
NPPES CertifiedMay 20, 2025
✔ NPI 1043002553 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyLicensed Practical NurseNursing Service Providers
Taxonomy Code164W00000X
License✔ Licensed in NY · 199332
Definition

A licensed practical nurse with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.

Also ListedCounselor · Addiction (Substance Use Disorder)Taxonomy 101YA0400X · License CASAC-38078 (NY)
153 WOODBURY AVE, Syracuse, NY 13206
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Secondary Practice Location 1

Location 1960 Salt Springs RdSyracuse, NY 13224-1696 · Phone (315) 446-6250 ext. 219

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Colleen Jackson's NPI number?

The NPI number for Colleen Jackson is 1043002553. It was assigned to this individual provider in the NPPES registry on May 20, 2025.

Where is Colleen Jackson located?

Colleen Jackson practices at 153 Woodbury Ave, Syracuse, NY 13206. The listed phone number is (315) 254-4884.

What is Colleen Jackson's specialty?

The primary specialty registered for this NPI is Licensed Practical Nurse with taxonomy code 164W00000X.

When was this NPI record last updated?

The NPPES record for Colleen Jackson was last updated on May 20, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.