SAMANTHA RAE JACKSON FNP-BC
NPI 1861960221
Nurse Practitioner - Family in Collinsville, IL

Q: What is Samantha Jackson's NPI number?

The NPI number for Samantha Jackson is 1861960221. It was assigned to this individual provider in the NPPES registry on November 5, 2018.

Q: What is Samantha Jackson'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 Samantha Jackson was last updated on November 5, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.

Active since November 05, 2018

320 SUMNER BLVD, COLLINSVILLE, IL 62234(618) 514-1170 Get Directions Write a Review

NPPES record last updated: November 5, 2018. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Samantha Rae Jackson Fnp-bc NPPES

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

SAMANTHA RAE JACKSON FNP-BC (NPI 1861960221) is an individual family provider in Collinsville, Illinois, licensed in Illinois (209017975) and active in the NPI registry since November 2018.

NPPES Registry Identity

NPI1861960221

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameSAMANTHA RAE JACKSONCredential: FNP-BC

Location Address320 SUMNER BLVDCollinsville, IL 62234-1929

Mailing Address320 Sumner BlvdCollinsville, IL 62234-1929 · (618) 514-1170

Phone(618) 514-1170

Sole ProprietorNo

Enumeration DateNovember 5, 2018

✔ NPI 1861960221 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 IL · 209017975

320 SUMNER BLVD, Collinsville, IL 62234

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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 Samantha Jackson's NPI number?

The NPI number for Samantha Jackson is 1861960221. It was assigned to this individual provider in the NPPES registry on November 5, 2018.

Where is Samantha Jackson located?

Samantha Jackson practices at 320 Sumner Blvd, Collinsville, IL 62234. The listed phone number is (618) 514-1170.

What is Samantha Jackson's specialty?

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

When was this NPI record last updated?

The NPPES record for Samantha Jackson was last updated on November 5, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.