KELLONTREIA LAPORCHE JACKSON A-GNP-C
NPI 1619685534
Nurse Practitioner - Gerontology in Hawkinsville, GA
About Kellontreia Laporche Jackson A-gnp-c NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KELLONTREIA LAPORCHE JACKSON A-GNP-C (NPI 1619685534) is an individual gerontology provider in Hawkinsville, Georgia, licensed in Georgia (NP259383) and active in the NPI registry since November 2022. She is enrolled in Medicare PECOS and is a graduate of Other (2022).
NPPES Registry Identity
Specialties & Licenses
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
Kellontreia Laporche Jackson A-gnp-c 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.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 31036 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 2
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
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 Kellontreia Jackson's NPI number?
The NPI number for Kellontreia Jackson is 1619685534. It was assigned to this individual provider in the NPPES registry on November 9, 2022.
Where is Kellontreia Jackson located?
Kellontreia Jackson practices at 37 341 Byp, Hawkinsville, GA 31036. The listed phone number is (478) 845-4842.
What is Kellontreia Jackson's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Gerontology, with taxonomy code 363LG0600X.
Is Kellontreia Jackson enrolled in Medicare?
Yes. Kellontreia 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 Kellontreia Jackson was last updated on May 13, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.
# Kellontreia Laporche Jackson, A-GNP-C · NPI 1619685534
Gerontology physician in Hawkinsville, Georgia. Individual provider, active in the CMS NPPES registry since November 9, 2022.
## Identity
- **NPI:** 1619685534 (Entity type: Individual)
- **Enumerated:** November 9, 2022
- **Primary specialty:** Nurse Practitioner - Gerontology · taxonomy 363LG0600X
- **State license:** NP259383 (Georgia)
- **Sole proprietor:** No
## Practice location
- **Address:** 37 341 BYP, Hawkinsville, GA 31036-4839
- **Phone:** (478) 845-4842
## 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:** Other, class of 2022
## Record status
- **NPPES last updated:** May 13, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1619685534) · Data from the CMS NPPES public registry.