Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1154586832 Individual Practitioner Female Practitioner

Dr. Kimberley Evelyn Jackson , DO

General Practice • Pueblo, CO

Professional Overview & Biography Verified Profile Summary

Dr. Kimberley Jackson, DO is a registered healthcare professional specializing in General Practice in Pueblo, CO. Practice services are available at 902 LAKEVIEW AVE under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

902 Lakeview Ave

Pueblo, CO 810043597

Telephone 7195575855
Fax 7195574690
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for General Practice in Pueblo, CO

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 18.4 Yrs
Regional Practice Density
6 Specialists

Practicing in Pueblo, CO (331 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

General Practice Primary Specialty

NUCC Taxonomy Code: 208D00000X

State License PA OS014960

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.

Additional State Medicaid & Healthcare Payer Identifiers

Commercial Insurance / Payer ID Pennsylvania Osteopathic Medical Board
OS014960 (PA)
Commercial Insurance / Payer ID Colorado License
50533 (CO)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

40 Associated Practitioners
Mark Davis , PA-C

Physician Assistant

NPI 1023304821

Physician Assistant (Certified)

Madison Bassett

Student in an Organized Health Care Education/Training Program

NPI 1033903703
Rebecka Reatherford , AGACNP-BC

Nurse Practitioner - Acute Care

NPI 1053895532

Adult-Gerontology Acute Care Nurse Practitioner (Board Certified)

Tiffany Garcia , FNP

Nurse Practitioner - Family

NPI 1154203172

Family Nurse Practitioner

NPI 1164656542

Doctor of Medicine (M.D.)

John De Villa , FNP-BC

Nurse Practitioner - Family

NPI 1205474210

Family Nurse Practitioner (Board Certified)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events
NPI Profile Active September 16, 2011

NPI status registered as active in NPPES database

📍
Updated Practice Location September 16, 2011

Registered at 902 LAKEVIEW AVE, PUEBLO, CO 810043597 (Tel: 7195575855)

📍
Updated Business Mailing Address September 16, 2011

Registered at 902 LAKEVIEW AVE, PUEBLO, CO 810043597 (Tel: 7195575855)

👤
Provider Name / Credentials Updated September 16, 2011

Recorded as KIMBERLEY JACKSON, D.O.

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) September 16, 2011

General Practice (License #OS014960 in PA)

🟢
Initial NPI Registration & Enumeration July 22, 2008

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1154586832
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: July 22, 2008
Last Update: September 16, 2011
Sole Proprietor: No

Mailing Address

902 Lakeview Ave

Pueblo, CO 810043597

Phone: 7195575855

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.