Tiffany Michelle Jackson, APRN, AGNP-C

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

A004646 Issued in AR

Practice address

12 E Appleby Rd
Suite 101
Fayetteville, AR 72703-3901

Phone

(479) 463-4444

Fax

(479) 463-4499

NPI assigned

Feb 3, 2016

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

Medicare fee-for-service enrollment

Enrolled in AR

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

Practice roles

Locations

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.

• Washington Regional Medical System

  • Family Medicine Physician
  • Springdale, AR
  • NPI 1326376419
  Medicare reassignment NPD
• Washington Regional Medical System

  • Multi-Specialty Clinic/Center
  • Fayetteville, AR
  • NPI 1699731208
  Medicare reassignment NPD
• Washington Regional Medical System

  • Family Medicine Physician
  • Farmington, AR
  • NPI 1275839011
  NPD

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

{
    "created_epoch": "1454457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470355200000",
    "number": "1114385374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 E APPLEBY RD",
            "address_2": "SUITE 101",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727033901",
            "telephone_number": "479-463-4444",
            "fax_number": "479-463-4499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 E APPLEBY RD",
            "address_2": "SUITE 101",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727033901",
            "telephone_number": "479-463-4444",
            "fax_number": "479-463-4499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "TIFFANY",
        "middle_name": "MICHELLE",
        "credential": "APRN, AGNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-02-03",
        "last_updated": "2016-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "AR",
            "license": "A004646",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Holly Jackson, DPT
• Kaitlin Jackson, MHPP
• Laura Lynn Jackson, PA-C
• Scott M Jackson, M.D.
• Tammie Jackson
• Jaclyn Start Dba Ozark Origins
• Anna C Jacob
• Sydney Allison Spillane Jacob, DO
• Ingrid Jacobs, PH.D.
• Lois Faye Jacoby, LCSW, LADC

• Primary Care Nurse Practitioner in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Primary Care Nurse Practitioner in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2016; 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.