Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

JACKIE MARYLINE BASSONG FNP-C, FNP-BC
NPI 1477296366
Nurse Practitioner - Family in Kennesaw, GA

Q: What is Jackie Bassong's NPI number?

The NPI number for Jackie Bassong is 1477296366. It was assigned to this individual provider in the NPPES registry on April 18, 2022.

Q: What is Jackie Bassong's specialty?

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

Q: When was this NPI record last updated?

The NPPES record for Jackie Bassong was last updated on June 19, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 56 days 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.

Active since April 18, 2022PECOS Enrolled

2782 N COBB PKWY, KENNESAW, GA 30152(866) 389-2727 Get Directions Write a Review

NPPES record last updated: June 19, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Jackie Maryline Bassong Fnp-c, Fnp-bc NPPES

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

JACKIE MARYLINE BASSONG FNP-C, FNP-BC (NPI 1477296366) is an individual family provider in Kennesaw, Georgia, licensed in Georgia (APRN-NP279714) and active in the NPI registry since April 2022. She is enrolled in Medicare PECOS and is a graduate of Other (2021).

NPPES Registry Identity

NPI1477296366

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameJACKIE MARYLINE BASSONGCredential: FNP-C, FNP-BC

Location Address2782 N COBB PKWYKennesaw, GA 30152-3472

Mailing Address2782 N Cobb PkwyKennesaw, GA 30152-3472

Phone(866) 389-2727

Sole ProprietorNo

Medical School CMSOtherGraduated 2021

Enumeration DateApril 18, 2022

Last NPPES UpdateJune 19, 2026

NPPES CertifiedJune 19, 2026

✔ NPI 1477296366 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 · APRN-NP279714

2782 N COBB PKWY, Kennesaw, GA 30152

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jackie Maryline Bassong Fnp-c, Fnp-bc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID749778959

PECOS Enrollment IDI20251022000574

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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 30152 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

$88.06 typical visit price

range $56.84 – $172.43

Typical copayment $22.01 (range $14.21 – $43.10)

Most-billed visit code 99203

Established Patient

$100.20 typical visit price

range $18.22 – $140.40

Typical copayment $25.05 (range $4.55 – $35.10)

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 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. CHAD RICHARD

Pharmacist