KENDRA JOY JACKSON MD
NPI 1649776469
Pediatrics - Pediatric Emergency Medicine in Baltimore, MD

Q: What is the provider's specialty?

The provider's specialty is Pediatrics with taxonomy code 2080P0204X and a focus in Pediatric Emergency Medicine.

Active since April 02, 2018PECOS Enrolled

1800 ORLEANS ST, BALTIMORE, MD 21287(410) 955-5000 Get Directions Write a Review

NPPES record last updated: September 6, 2024. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Sep 6, 2024, Aug 5, 2024, Apr 12, 2024 and 9 more (12 updates tracked since 2021).

On this page

About Kendra Joy Jackson Md NPPES

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

KENDRA JOY JACKSON MD (NPI 1649776469) is an individual pediatric emergency medicine provider in Baltimore, Maryland, licensed in Maryland (D0099966) and active in the NPI registry since April 2018. She is enrolled in Medicare PECOS and maintains a secondary practice location in Baltimore.

NPPES Registry Identity

NPI1649776469

Entity TypeIndividualFemale

Primary Taxonomy2080P0204X

Provider Legal NameKENDRA JOY JACKSONCredential: MD

Location Address1800 ORLEANS STBaltimore, MD 21287-0010

Mailing Address6201 Greenleigh AveMiddle River, MD 21220-2004 · (410) 933-6423 · Fax (410) 500-4266

Phone(410) 955-5000

Sole ProprietorNo

Enumeration DateApril 2, 2018

Last NPPES UpdateSeptember 6, 202412 updates tracked since enumeration

NPPES CertifiedSeptember 6, 2024

✔ NPI 1649776469 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPediatrics · Pediatric Emergency MedicineAllopathic & Osteopathic Physicians

Taxonomy Code2080P0204X

License✔ Licensed in MD · D0099966

Definition

A pediatrician who has special qualifications to manage emergencies in infants and children.

Also ListedPediatricsTaxonomy 208000000X · License D0099966 (MD)

1800 ORLEANS ST, Baltimore, MD 21287

Open in Google Maps ↗

Secondary Practice Location 1

Location 1600 N Wolfe StBaltimore, MD 21287-0005 · Phone (410) 955-5000

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kendra Joy Jackson Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.