Active NPI
Nisha Jackson PC
- Nurse Practitioner
- Medford, OR
National Provider Identifier
1124499124
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 086006299N7
- Legal business name
- NISHA JACKSON PC
- Practice address
- 3265 Hillcrest Park Dr
Medford, OR 97504-7657 - Phone
- (541) 494-9355
- Fax
- (541) 210-8724
- NPI assigned
- Oct 15, 2015
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Karissa Stults
- Title
- VP of Billing and Contracting
- Phone
- (541) 930-8545
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 086006299N7 | OR | Primary |
Addresses
Primary practice location
3265 Hillcrest Park Dr
Medford, OR 97504-7657
Mailing address
3265 Hillcrest Park Dr
Medford, OR 97504-7657
Phone (541) 494-9355
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 012158 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20151209000878 | OR | Part B Supplier - Clinic/Group Practice | 6305147745 |
Receives reassigned benefits from 57 practitioners Practice locations: White City, OR; Springfield, OR; Roseburg, OR; Redmond, OR; Medford, OR; McMinnville, OR; Lake Oswego, OR; Grants Pass, OR… |
National Provider Directory
National Provider DirectoryLocations
1803 14th Ave SE
Albany, OR 97322
Phone (541) 704-7670
2590 Woodland Dr
Coos Bay, OR 97420
Phone (541) 217-2022
902 Country CLB Rd
Ste 201
Eugene, OR 97401
Phone (541) 204-4745
3236 Hillcrest Park Dr
Medford, OR 97504
Phone (541) 210-8721
2775 SW 17th Pl
Redmond, OR 97756
Phone (541) 330-1975
3312 Gateway St
Springfield, OR 97477
Phone (541) 393-1037
Practitioners & affiliated clinicians
Practitioners 72
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1444867200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1785456000000",
"number": "1124499124",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3265 HILLCREST PARK DR",
"city": "MEDFORD",
"state": "OR",
"postal_code": "975047657",
"telephone_number": "541-494-9355",
"fax_number": "541-494-0945"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3265 HILLCREST PARK DR",
"city": "MEDFORD",
"state": "OR",
"postal_code": "975047657",
"telephone_number": "541-494-9355",
"fax_number": "541-210-8724"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "NISHA JACKSON PC",
"organizational_subpart": "NO",
"enumeration_date": "2015-10-15",
"last_updated": "2026-07-31",
"certification_date": "2026-07-31",
"status": "A",
"authorized_official_last_name": "STULTS",
"authorized_official_first_name": "KARISSA",
"authorized_official_title_or_position": "VP OF BILLING AND CONTRACTING",
"authorized_official_telephone_number": "541-930-8545"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Nurse Practitioner",
"state": "OR",
"license": "086006299N7",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "012158",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Medford, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.