KIMMERLY JACKSON FNP
NPI 1972366086
Nurse Practitioner - Family in Buffalo, NY

Q: What is Kimmerly Jackson's NPI number?

The NPI number for Kimmerly Jackson is 1972366086. It was assigned to this individual provider in the NPPES registry on February 1, 2024.

Q: What is Kimmerly 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 Kimmerly Jackson was last updated on February 1, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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 February 01, 2024PECOS EnrolledAccepts Medicare Assignment

184 BARTON ST, BUFFALO, NY 14213(716) 881-6191(716) 881-6247 Get Directions Write a Review

NPPES record last updated: February 1, 2024. Verified against the NPPES registry weekly; last sync: November 08, 2026.

On this page

About Kimmerly Jackson Fnp NPPES

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

KIMMERLY JACKSON FNP (NPI 1972366086) is an individual family provider in Buffalo, New York, licensed in New York (353174) and active in the NPI registry since February 2024. She is enrolled in Medicare PECOS and is a graduate of Other (2023).

NPPES Registry Identity

NPI1972366086

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameKIMMERLY JACKSONCredential: FNP

Location Address184 BARTON STBuffalo, NY 14213-1573

Mailing Address184 Barton StBuffalo, NY 14213-1573 · (716) 881-6191 · Fax (716) 881-6247

Phone(716) 881-6191

Fax(716) 881-6247

Sole ProprietorNo

Medical School CMSOtherGraduated 2023

Enumeration DateFebruary 1, 2024

NPPES CertifiedFebruary 1, 2024

✔ NPI 1972366086 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 NY · 353174

184 BARTON ST, Buffalo, NY 14213

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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 and accepts Medicare assignment

Kimmerly Jackson Fnp 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.

PECOS PAC ID6800023250

PECOS Enrollment IDI20240220002263

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 Kimmerly Jackson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Jericho Road Ministries Inc.

Same address

Federally Qualified Health Center (FQHC)

184 BARTON ST
Buffalo, NY 14213

Reassigned Medicare billing, New York enrollment
40 clinicians in this Medicare group

NPI 1972944080 (716) 881-6191

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

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 14213 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

$84.93 typical visit price

range $54.87 – $166.88

Typical copayment $21.23 (range $13.71 – $41.72)

Most-billed visit code 99203

Established Patient

$97.08 typical visit price

range $17.54 – $136.14

Typical copayment $24.27 (range $4.38 – $34.03)

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. SERGHEI FLOREA PHARM.D.

Pharmacist