Lora A Jackson, NP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

78444 Issued in CO

Practice address

4185 E Wildcat Reserve Pkwy
Ste 100
Highlands Ranch, CO 80126-6801

Phone

(303) 791-7896

Fax

(303) 791-8152

NPI assigned

Jan 25, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Southpark Internal Medicine PC

  • Internal Medicine Physician
  • Highlands Ranch, CO
  • NPI 1538293790
  NPD (past)

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1083760938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4185 E WILDCAT RESERVE PKWY",
            "address_2": "STE 100",
            "city": "HIGHLANDS RANCH",
            "state": "CO",
            "postal_code": "801266801",
            "telephone_number": "303-791-7896",
            "fax_number": "303-791-8152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4185 E WILDCAT RESERVE PKWY",
            "address_2": "STE 100",
            "city": "HIGHLANDS RANCH",
            "state": "CO",
            "postal_code": "801266801",
            "telephone_number": "303-791-7896",
            "fax_number": "303-791-8152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "LORA",
        "middle_name": "A",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CO",
            "license": "78444",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NURSE LICENSE",
            "identifier": "78444",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Intermountain Medical Group Denver, LLC (Intermountain Health Heart & Vascular - Highlands Ranch)
• Summer Renee Irelan, PA-C, MMS
• Ivy Comprehensive Care LLC
• Tatyana Izrailev, PHARMD
• J Co Physical Therapy (MVMT Loft)
• Michelle A Jackson
• Sephora Chantal Jacob, LMT
• Jodi Jacobs, LCSW
• Lawrence L Jacobs, O.D.
• Michael Grant Jacobs, D.D.S

• Adult Health Nurse Practitioner in Highlands Ranch, CO
• Providers in Highlands Ranch, CO by specialty
• Adult Health Nurse Practitioner in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.