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

Kelly Len Jackson, NP

Individual provider Oncology Registered Nurse · NPI 1174761498

Kelly Len Jackson, NP is a Nurse Practitioner in Lawrenceville, Georgia. Graduated from Medical College of Georgia School of Medicine in 2008, 18 years ago. Practices with Northside Surgical Professional Services LLC, a 368-clinician group and accepts Medicare assignment. Licensed in Georgia.

Years since qualifying
18
Trained at
Medical College of Georgia School of Medicine
Licensed in
GA
In the registry since
2009
What do these letters mean?
NP — Nurse Practitioner
An advanced practice nurse who can diagnose, treat and in most states prescribe.

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Practice location Address checks out

771 Old Norcross Rd Ste 165
Lawrenceville, GA 30046-4979
Phone: (678) 442-3121
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Oncology Registered Nurse (primary) Taxonomy 163WX0200X · Licence RN143526 (GA)

Record details

NPI number1174761498
Entity typeIndividual (Type 1)
GenderFemale
Credentials NP
Sole proprietorNo
NPI enumeratedJanuary 23, 2009
Last updated in NPPESNovember 16, 2025
Certification dateNovember 16, 2025

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolMEDICAL COLLEGE OF GEORGIA SCHOOL OF MEDICINE
Graduated 2008 (18 years in practice)
Group practice Northside Surgical Professional Services Llc — 368 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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