Patricia L Jackson, APRN

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

43087 Issued in WY

Practice address

1252 N 22ND St Unit a
Laramie, WY 82072-5306

Phone

(307) 745-5364

Fax

(307) 745-4164

NPI assigned

Aug 13, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554336000000",
    "number": "1073525150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1252 N 22ND ST UNIT A",
            "city": "LARAMIE",
            "state": "WY",
            "postal_code": "820725306",
            "telephone_number": "307-745-5364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1252 N 22ND ST UNIT A",
            "city": "LARAMIE",
            "state": "WY",
            "postal_code": "820725306",
            "telephone_number": "307-745-5364",
            "fax_number": "307-745-4164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "PATRICIA",
        "middle_name": "L",
        "name_prefix": "Ms.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-13",
        "last_updated": "2019-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WY",
            "license": "43087",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CT",
            "license": "4708",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ivinson Memorial Hospital
• Diahann Jablin, RPH,BS PHARM
• Jackson Hole Behavioral Services, LLC
• Christopher Jackson
• Lani Jackson, CMT
• Teresa J Jacobs Castano, LCSW LAT
• Eric Jacobs
• John Jacobs III, NP-C
• Aspen Jairell
• Mandy Jane Jairell, D.C.

• Nurse Practitioner in Laramie, WY
• Providers in Laramie, WY by specialty
• Nurse Practitioner in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.