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

Kelly Nicole Jackson, FNP

Individual provider Family Nurse Practitioner · NPI 1306505854

Kelly Nicole Jackson, FNP is a Nurse Practitioner in Kingsport, Tennessee. Qualified in 2021, 5 years ago. Licensed in Tennessee.

Years since qualifying
5
Licensed in
TN
In the registry since
2021
What do these letters mean?
FNP — Family Nurse Practitioner
A nurse practitioner who treats patients of all ages, much like a family doctor.

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Practice location Address checks out

4 Sheridan Sq Ste 102
Kingsport, TN 37660-7435
Phone: (423) 588-7140
Fax: (423) 588-7141
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 30680 (TN)

Record details

NPI number1306505854
Entity typeIndividual (Type 1)
GenderFemale
Credentials FNP
Sole proprietorNo
NPI enumeratedDecember 13, 2021
Last updated in NPPESMay 21, 2026
Certification dateMay 21, 2026

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Accepts Medicare assignment Not indicated
Practice locations3 on file with Medicare

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