NICHOLAS DWAYNE JACKSON, PharmD — NPI 1528670916 (Licensed & Credentialed Pharmacist in COEBURN, VA)

CMS-1500 Box 24J / 33a • NPI

1528670916

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

183500000X

Licensed & Credentialed Pharmacist

Box 32 Service Location & ZIP+4

201 LAUREL AVE, COEBURN, VA, 24293

Official NPPES Practice Location

Practice Phone & Referral Fax

(276) 807-7106

Fax: (276) 807-7341

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1528670916 (NICHOLAS DWAYNE JACKSON, PharmD) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1528670916` (NPI-1 Individual Practitioner)
Provider / Legal Name	NICHOLAS DWAYNE JACKSON, PharmD
Plain-English Specialty	Licensed & Credentialed Pharmacist NUCC Code: `183500000X` (Pharmacist)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	201 LAUREL AVE, COEBURN, VA, 24293
Practice Telephone / Fax	Tel: (276) 807-7106 \| Fax: (276) 807-7341
Administrative Mailing Address	PO BOX 1439, COEBURN, VA, 24230-1439
Enumeration & Last Sync	Enumerated: 2020-08-18 \| CMS Record Updated: 2020-08-18

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

201 LAUREL AVE, COEBURN, VA, 24293

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Plain-English Taxonomy & CMS Crosswalk (183500000X)

What Does Taxonomy Code 183500000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 183500000X translates to:
"Licensed & Credentialed Pharmacist"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Pharmacist for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (NICHOLAS DWAYNE JACKSON, PharmD)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`183500000X` — Pharmacist Plain English: Licensed & Credentialed Pharmacist	State: VA \| License: `0202208432` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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NICHOLAS DWAYNE JACKSON, PharmD (NPI #1528670916)