Kellontreia Laporche Jackson, A-GNP-C in Hawkinsville, GA

Kellontreia Laporche Jackson, A-GNP-C is a medicare enrolled "Nurse Practitioner - Gerontology" in Hawkinsville, Georgia. She graduated from nursing school in 2022 and has 4 years of diverse experience with area of expertise as Nurse Practitioner. She is a member of the group practice Topaz Bay Senior Health Pc and her current practice location is 37 341 Byp, Hawkinsville, Georgia. You can reach out to her office (for appointments etc.) via phone at (478) 845-4842.

Kellontreia Laporche Jackson is licensed to practice in Georgia (license number NP259383) 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 1619685534.

Contact Information

	Kellontreia Laporche Jackson, A-GNP-C
	37 341 Byp, Hawkinsville, GA 31036-4839
	(478) 845-4842
	Not Available

Map and Direction

Provider's Profile

Full Name	Kellontreia Laporche Jackson
Gender	Female
Speciality	Nurse Practitioner
Experience	4 Years
Location	37 341 Byp, Hawkinsville, Georgia
Accepts Medicare Assignments	Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.

Medical Education and Training:

Kellontreia Laporche Jackson graduated from nursing school in 2022

NPI Data:

NPI Number: 1619685534
Provider Enumeration Date: 11/09/2022
Last Update Date: 05/13/2026

Medicare PECOS Information:

PECOS PAC ID: 0446627947
Enrollment ID: I20221111000944

Medical Identifiers

Medical identifiers for Kellontreia Laporche Jackson such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1619685534	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LG0600X	Nurse Practitioner - Gerontology	4704420181 (Michigan)	Secondary
363LG0600X	Nurse Practitioner - Gerontology	NP259383 (Georgia)	Primary
363LG0600X	Nurse Practitioner - Gerontology	1176633 (Texas)	Secondary
363LG0600X	Nurse Practitioner - Gerontology	H181146 (Iowa)	Secondary
363LG0600X	Nurse Practitioner - Gerontology	C-APN.0102805-C-NP (Colorado)	Secondary
363LG0600X	Nurse Practitioner - Gerontology	36993 (Tennessee)	Secondary

Group Practice Association

Group Practice Name	Group PECOS PAC ID	No. of Members
Topaz Bay Senior Health Pc	2860906385	30

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. Kellontreia Laporche Jackson allows following entities to bill medicare on her behalf.

Entity Name	Qofl Services Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1942554837 PECOS PAC ID: 6709030133 Enrollment ID: O20140203001266

Entity Name	Qcpi-villagemd Pc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1558872432 PECOS PAC ID: 8123389277 Enrollment ID: O20180306001224

Entity Name	Theoria Medical
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1609362375 PECOS PAC ID: 5395098339 Enrollment ID: O20230105001168

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. Kellontreia Laporche 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
Kellontreia Laporche Jackson, A-GNP-C 4196 Highway 62 412 Ste A, Hardy, AR 72542-8002 Ph: () -	Kellontreia Laporche Jackson, A-GNP-C 37 341 Byp, Hawkinsville, GA 31036-4839 Ph: (478) 845-4842

Reviews and Comments

Nurse Practitioner Nurses in Hawkinsville, GA

Haylee Ward, NP-C Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 373 Upper River Rd, Hawkinsville, GA 31036 Phone: 478-783-6000
Bailey F Lanier, NP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 222 Perry Hwy, Hawkinsville, GA 31036 Phone: 478-783-2273 Fax: 478-783-2272
Laura Mcdonald, FNP, MSN Nurse Practitioner Medicare: May Accept Medicare Assignments Practice Location: 155 Commerce St, Hawkinsville, GA 31036 Phone: 478-922-4010
Lauren Cravey Speight, APRN Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 37 Hwy 341 Bypass, Hawkinsville, GA 31036 Phone: 478-845-4842
Mr. James C Smith, NP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 259 Broad St, Hawkinsville, GA 31036 Phone: 478-300-7107 Fax: 478-783-3961
Jessica L Newby, NP-C Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 202 Perry Hwy, Hawkinsville, GA 31036 Phone: 478-783-3399
Alisha M Register, NP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 373 Upper River Rd., Hawkinsville, GA 31036 Phone: 478-783-6110

Kellontreia Laporche Jackson, A-GNP-C - Medicare Nurse Practitioner in Hawkinsville, GA