Active NPI
Andrece Jackson, RN
- Registered Nurse
- Tuba City, AZ
National Provider Identifier
1003351255
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 240457-8
- Practice address
- 167 North Main Street
Tuba City, AZ 86045-0600 - Phone
- (928) 283-2094
- Fax
- (928) 283-2677
- NPI assigned
- Dec 27, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 240457-8 | MN | Primary |
Addresses
Primary practice location
167 North Main Street
Tuba City, AZ 86045-0600
Mailing address
PO Box 600
Tuba City, AZ 86045-0600
Phone (928) 283-2094
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 240457-8 | MN | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1482796800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1482796800000",
"number": "1003351255",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 600",
"city": "TUBA CITY",
"state": "AZ",
"postal_code": "860450600",
"telephone_number": "928-283-2094",
"fax_number": "928-283-2677"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "167 NORTH MAIN STREET",
"city": "TUBA CITY",
"state": "AZ",
"postal_code": "860450600",
"telephone_number": "928-283-2094",
"fax_number": "928-283-2677"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "ANDRECE",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-12-27",
"last_updated": "2016-12-27",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "MN",
"license": "240457-8",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tuba City, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.