KELLY A JACKSON NP-C
NPI 1205111317
Nurse Practitioner - Family in Scottsdale, AZ
About Kelly A Jackson Np-c NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KELLY A JACKSON NP-C (NPI 1205111317) is an individual family provider in Scottsdale, Arizona, licensed in Arizona (AP4200) and active in the NPI registry since October 2011. She is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Kelly A Jackson Np-c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Kelly Jackson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Scottsdale, AZ 85251
- Reassigned Medicare billing, Arizona enrollment
- 822 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 85251 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
SCOTTSDALE, AZ 85251
SCOTTSDALE, AZ 85251
SCOTTSDALE, AZ 85251
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 1205111317. It was assigned to this individual provider in the NPPES registry on October 20, 2011.
Where is Kelly Jackson located?
Kelly Jackson practices at 7400 E Osborn Rd, Scottsdale, AZ 85251. The listed phone number is (480) 882-6958.
What is Kelly Jackson's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Kelly Jackson enrolled in Medicare?
Yes. Kelly Jackson is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Kelly Jackson's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Kelly Jackson reassigns Medicare benefits to Honorhealth Ambulatory (Scottsdale, AZ). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kelly Jackson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Kelly Jackson was last updated on October 20, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years 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 A Jackson, NP-C · NPI 1205111317
Family physician in Scottsdale, Arizona. Individual provider, active in the CMS NPPES registry since October 20, 2011.
## Identity
- **NPI:** 1205111317 (Entity type: Individual)
- **Enumerated:** October 20, 2011
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **State license:** AP4200 (Arizona)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 7400 E OSBORN RD, Scottsdale, AZ 85251-6432
- **Phone:** (480) 882-6958
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Honorhealth Ambulatory (NPI 1053881938, Scottsdale, AZ), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** October 20, 2011
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Source: [NPI Profile](https://npiprofile.com/npi/1205111317) · Data from the CMS NPPES public registry.