Dr Ellanikole Jackson, DNP is a medicare enrolled "Nurse Practitioner - Family" in Counce, Tennessee. She graduated from nursing school in 2018 and has 6 years of diverse experience with area of expertise as Nurse Practitioner. She is a member of the group practice Family Clinic At The Lake Pllc and her current practice location is
11268 Highway 57, Counce, Tennessee. You can reach out to her office (for appointments etc.) via phone at
(731) 438-3456.
Dr Ellanikole Jackson is licensed to practice in Tennessee (license number 24869) and she also participates in the medicare program. She
accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1932676194.
Provider's Profile
| Full Name | Dr Ellanikole Jackson |
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| Gender | Female |
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| Speciality | Nurse Practitioner |
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| Experience | 6 Years |
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| Location | 11268 Highway 57, Counce, Tennessee |
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| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Dr Ellanikole Jackson graduated from nursing school in 2018
NPI Data:
- NPI Number: 1932676194
- Provider Enumeration Date: 10/25/2018
- Last Update Date: 10/25/2018
Medicare PECOS Information:
- PECOS PAC ID: 9335484914
- Enrollment ID: I20181231001911
Medical Identifiers
Medical identifiers for Dr Ellanikole Jackson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1932676194 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363LF0000X | Nurse Practitioner - Family | 24869 (Tennessee) | Primary |
Medical Facilities Affiliation
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|
| Family Clinic At The Lake Pllc | 7012246069 | 2 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Ellanikole Jackson allows following entities to bill medicare on her behalf.
| Entity Name | Family Clinic At The Lake Pllc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1578125647
PECOS PAC ID: 7012246069
Enrollment ID: O20190917001247 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Ellanikole Jackson is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Ellanikole Jackson, DNP
25 Recreation Ln,
Counce, TN 38326-3496
Ph: (901) 500-8629 | Dr Ellanikole Jackson, DNP
11268 Highway 57,
Counce, TN 38326-3802
Ph: (731) 438-3456 |
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