KELLY LEN JACKSON N.P.
NPI 1174761498
Registered Nurse - Oncology in Lawrenceville, GA
About Kelly Len Jackson N.p. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KELLY LEN JACKSON N.P. (NPI 1174761498) is an individual oncology provider in Lawrenceville, Georgia, licensed in Georgia (RN143526) and active in the NPI registry since January 2009. She is enrolled in Medicare PECOS and is a graduate of Medical College Of Georgia School Of Medicine (2008).
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Kelly Len Jackson N.p. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Other Providers at the Same Location NPPES 2
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
LAWRENCEVILLE, GA 30046
LAWRENCEVILLE, GA 30046
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 Kelly Jackson's NPI number?
The NPI number for Kelly Jackson is 1174761498. It was assigned to this individual provider in the NPPES registry on January 23, 2009. The provider is also known as Kelly Len Brandenberger.
Where is Kelly Jackson located?
Kelly Jackson practices at 771 Old Norcross Rd Ste 165, Lawrenceville, GA 30046. The listed phone number is (678) 442-3121.
What is Kelly Jackson's specialty?
The primary specialty registered for this NPI is Registered Nurse, specializing in Oncology, with taxonomy code 163WX0200X.
Is Kelly Jackson enrolled in Medicare?
Yes. Kelly Jackson is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
When was this NPI record last updated?
The NPPES record for Kelly Jackson was last updated on November 16, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Kelly Len Jackson, N.P. · NPI 1174761498
Oncology provider in Lawrenceville, Georgia. Individual provider, active in the CMS NPPES registry since January 23, 2009.
## Identity
- **NPI:** 1174761498 (Entity type: Individual)
- **Enumerated:** January 23, 2009
- **Primary specialty:** Registered Nurse - Oncology · taxonomy 163WX0200X
- **State license:** RN143526 (Georgia)
- **Sole proprietor:** No
## Practice location
- **Address:** 771 OLD NORCROSS RD STE 165, Lawrenceville, GA 30046-4979
- **Phone:** (678) 442-3121
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Medical school:** Medical College Of Georgia School Of Medicine, class of 2008
## Record status
- **NPPES last updated:** November 16, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1174761498) · Data from the CMS NPPES public registry.