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MS. COURTNEY TAMARA JACKSON NP
NPI 1457966509
Nurse Practitioner - Family in Valdosta, GA

Active since September 14, 2020PECOS Enrolled
407 COWART AVE, VALDOSTA, GA 31602(229) 242-1187 Get Directions Write a Review

NPPES record last updated: September 14, 2020. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Ms. Courtney Tamara Jackson Np NPPES

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

MS. COURTNEY TAMARA JACKSON NP (NPI 1457966509) is an individual family provider in Valdosta, Georgia, licensed in Georgia (F09200417) and active in the NPI registry since September 2020. She is enrolled in Medicare PECOS and is a graduate of Other (2020).

NPPES Registry Identity

NPI1457966509
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameMS. COURTNEY TAMARA JACKSONCredential: NP
Location Address407 COWART AVEValdosta, GA 31602-2635
Mailing Address5380 Jackson RdMorven, GA 31638-3935 · (229) 292-6275
Phone(229) 242-1187
Sole ProprietorNo
Medical School CMSOtherGraduated 2020
Enumeration DateSeptember 14, 2020
NPPES CertifiedSeptember 14, 2020
✔ NPI 1457966509 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in GA · F09200417
407 COWART AVE, Valdosta, GA 31602
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Ms. Courtney Tamara Jackson Np is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID5395143630
PECOS Enrollment IDI20211018000913
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Courtney Jackson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Pruitthealth Hospice, Inc
Same address
Hospice Care, Community Based
407 COWART AVE
Valdosta, GA 31602
  • Reassigned Medicare billing, Georgia enrollment
  • 47 clinicians in this Medicare group
NPI 1063450666 (229) 242-1187

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Residence visit for established patient with moderate level of medical decision making, per day, if using time, at least 40 minutes 99349
An established patient home visit is a medical appointment conducted at your home, typically lasting around 40 minutes. This service is ideal for patients who may find it difficult to travel to a healthcare facility. During this visit, a healthcare professional will evaluate your health status, manage your care, and answer any health-related questions you may have.
62 services15 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 31602 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$83.23 typical visit price
range $53.31 – $164.04
Typical copayment $20.80 (range $13.32 – $41.01)
Most-billed visit code 99203
Established Patient
$94.84 typical visit price
range $16.68 – $133.24
Typical copayment $23.71 (range $4.17 – $33.31)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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.

PRUITTHEALTH HOSPICE, INC
Hospice Care, Community Based
407 COWART AVE
VALDOSTA, GA 31602
Lowndes County (229) 242-1187
SHALETA PREASTER LCSW
Social Worker (Clinical)
407 COWART AVE
VALDOSTA, GA 31602
Lowndes County (229) 834-1659

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 Courtney Jackson's NPI number?

The NPI number for Courtney Jackson is 1457966509. It was assigned to this individual provider in the NPPES registry on September 14, 2020.

Where is Courtney Jackson located?

Courtney Jackson practices at 407 Cowart Ave, Valdosta, GA 31602. The listed phone number is (229) 242-1187.

What is Courtney Jackson's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Courtney Jackson enrolled in Medicare?

Yes. Courtney Jackson is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Courtney Jackson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Courtney Jackson reassigns Medicare benefits to Pruitthealth Hospice, Inc (Valdosta, GA). 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 Courtney 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 Courtney Jackson was last updated on September 14, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.