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

Nicole Jackson

Individual provider Family Nurse Practitioner · NPI 1043753403

Nicole Jackson is a Nurse Practitioner in Columbus, Ohio. Qualified in 2016, 10 years ago. Practices with Maumee Valley Guidance Center Inc, a 7-clinician group and offers telehealth. Licensed in Ohio.

Years since qualifying
10
Licensed in
OH
In the registry since
2016
Specialties on file
2
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Practice location Address checks out

4646 Hilton Corporate Dr
Columbus, OH 43232-4147
Phone: (614) 914-4541
Fax: (614) 866-8580
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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 020277 (OH)
Family Nurse Practitioner Taxonomy 363LF0000X · Licence 020277 (OH)

Record details

NPI number1043753403
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedDecember 2, 2016
Last updated in NPPESMay 30, 2025
Certification dateMay 30, 2025

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2016 (10 years in practice)
Group practice Maumee Valley Guidance Center Inc — 7 clinicians
Accepts Medicare assignment Not indicated
TelehealthOffers telehealth services
Practice locations2 on file with Medicare

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