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

Kellontreia Laporche Jackson, A-GNP-C

Individual provider Gerontology Nurse Practitioner · NPI 1619685534

Kellontreia Laporche Jackson, A-GNP-C is a Nurse Practitioner in Hawkinsville, Georgia. Qualified in 2022, 4 years ago. Practices with Topaz Bay Senior Health PC, a 30-clinician group and accepts Medicare assignment. Licensed in Colorado, Georgia, Iowa and Michigan and 2 more.

Years since qualifying
4
Licensed in
CO, GA, IA, MI, TN, TX
In the registry since
2022
Specialties on file
6

Practice location Address checks out

37 341 Byp
Hawkinsville, GA 31036-4839
Phone: (478) 845-4842
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Gerontology Nurse Practitioner (primary) Taxonomy 363LG0600X · Licence NP259383 (GA)
Gerontology Nurse Practitioner Taxonomy 363LG0600X · Licence 4704420181 (MI)
Gerontology Nurse Practitioner Taxonomy 363LG0600X · Licence 1176633 (TX)
Gerontology Nurse Practitioner Taxonomy 363LG0600X · Licence H181146 (IA)
Gerontology Nurse Practitioner Taxonomy 363LG0600X · Licence C-APN.0102805-C-NP (CO)
Gerontology Nurse Practitioner Taxonomy 363LG0600X · Licence 36993 (TN)

Record details

NPI number1619685534
Entity typeIndividual (Type 1)
GenderFemale
Credentials A-GNP-C
Sole proprietorNo
NPI enumeratedNovember 9, 2022
Last updated in NPPESMay 13, 2026
Certification dateMay 13, 2026

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Topaz Bay Senior Health Pc — 30 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Hawkinsville