Karissa Keagan Jackson, ACNPC-AG

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

7120828-4405 Issued in UT

Practice address

1776 Park Ave Ste 211
Park City, UT 84060-5148

Phone

(385) 464-3980

Fax

(385) 464-3990

NPI assigned

Feb 18, 2020

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 names 1

• Karissa Keagan Jungerman Former name

Medicare fee-for-service enrollment

Enrolled in UT

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.

• Ihc Health Services Inc

  • Multi-Specialty Clinic/Center
  • Murray, UT
  • NPI 1629260880
  Medicare reassignment NPD
• Neurosurgical Associates LLC

  • Neurological Surgery Physician
  • Murray, UT
  • NPI 1477695187
  Medicare reassignment NPD
• Ihc Health Services Inc

  • Multi-Specialty Clinic/Center
  • Provo, UT
  • NPI 1477678589
  NPD
• Ihc Health Services, Inc.

  • Psychiatry Physician
  • St George, UT
  • NPI 1023843844
  NPD

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

{
    "created_epoch": "1581984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717286400000",
    "number": "1164055109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1776 PARK AVE STE 211",
            "city": "PARK CITY",
            "state": "UT",
            "postal_code": "840605148",
            "telephone_number": "385-464-3980",
            "fax_number": "385-464-3990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1776 PARK AVE STE 211",
            "city": "PARK CITY",
            "state": "UT",
            "postal_code": "840605148",
            "telephone_number": "385-464-3980",
            "fax_number": "385-464-3990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KARISSA",
        "middle_name": "KEAGAN",
        "credential": "ACNPC-AG",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-18",
        "last_updated": "2024-06-02",
        "certification_date": "2023-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "UT",
            "license": "7120828-4405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KARISSA",
            "last_name": "JUNGERMAN",
            "middle_name": "KEAGAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Integral Behavioral Health Services, LLC
• Iron Horse PT
• Nina Ivanova
• Katherine Ivers, ATC
• Dan Ivie, P.T
• Elizabeth Comfort Jacobsen, WHNP-BC
• Margaret Afton Jahries, APRN
• Mark W Jankowske, D.O.
• Kelsey Rose Janusch, NP-C
• Jasima Reynolds

• Acute Care Nurse Practitioner in Park City, UT
• Providers in Park City, UT by specialty
• Acute Care Nurse Practitioner in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2024; 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.