Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Becky A Jacks

Individual provider Psychiatric/Mental Health Nurse Practitioner · NPI 1245911767

Becky A Jacks is a Nurse Practitioner in Waldorf, Maryland. Qualified in 2023, 3 years ago. Practices with Kirstin's Haven, Inc, a 3-clinician group and accepts Medicare assignment. Licensed in Maryland.

Years since qualifying
3
Licensed in
MD
In the registry since
2023
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Practice location Address checks out

11100 Billingsley Rd
Waldorf, MD 20602-3400
Phone: (301) 357-4199
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X · Licence R232693 (MD)

Record details

NPI number1245911767
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedJuly 27, 2023
Last updated in NPPESJuly 27, 2023
Certification dateJuly 27, 2023
Mailing address11100 Billingsley Rd, Waldorf, MD 20602-3400

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Kirstin'S Haven, Inc — 3 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Waldorf