NPIMap

Individual provider Active NPI

Jessica A Nybakken, FNP

  • Nurse Practitioner
  • Staples, MN
National Provider Identifier
1164657607
Registry record updated Feb 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
2322 Issued in MN
Practice address
49725 County 83
Staples, MN 56479-5280
Phone
(218) 894-1515
Fax
(218) 894-8767
NPI assigned
May 28, 2009
Last updated
Feb 22, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 2322 MN Primary

Addresses

Primary practice location

49725 County 83
Staples, MN 56479-5280

Mailing address

49725 County 83
Staples, MN 56479-5280
Phone (218) 894-1515

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091027000419 MN Practitioner - Nurse Practitioner 8426195264 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lakewood Health SystemGroup PAC ID 1052229671, 107 clinicians

Practice addresses (Care Compare)

49725 County
Suite 83
Staples, MN 56479-5280
Phone (218) 894-1515

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Brainerd Medical Center Inc. CurrentSince Aug 29, 2009 Accepting new patients
St Joseph's Medical Center CurrentSince Aug 25, 2009 Accepting new patients
Brainerd Medical Center Inc CurrentSince Aug 29, 2009 Accepting new patients
The Duluth Clinic, LTD CurrentSince Jan 3, 2011 Accepting new patients
Lakewood Health System Current Accepting new patients
St. Joseph's Medical Center CurrentSince Aug 25, 2009 Accepting new patients
Lakewood Health System CurrentSince Apr 6, 2015 Accepting new patients
Lakewood Health System CurrentSince Apr 6, 2015 Accepting new patients
The Duluth Clinic, LTD. CurrentSince Jan 3, 2011 Accepting new patients
St. Joseph's Medical Center Current Accepting new patients
The Duluth Clinic LTD Current Accepting new patients
Lakewood Health System Past Accepting new patients

Locations

200 Bunker Hill Dr
Aitkin, MN 56431
Phone (218) 927-2121

2024 S 6th St
Brainerd, MN 56401
Phone (218) 828-2880

523 N 3rd St
Brainerd, MN 56401
Phone (218) 828-7394

13060 Isle Dr
Brainerd, MN 56425
Phone (218) 454-5920

400 E 3rd St
Duluth, MN 55805
Phone (218) 722-8364

200 Elm St N
Onamia, MN 56359
Phone (320) 532-2750

680 Pillsbury St N
#C63360
Pillager, MN 56473
Phone (218) 746-4527

49725 County 83
Staples, MN 56479
Phone (218) 894-1033

Interoperability endpoints

  • Direct secure messaging: jnybakken665946@direct.ochin.org

Organizations & group practices 12

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

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1243468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708560000000",
    "number": "1164657607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "49725 COUNTY 83",
            "city": "STAPLES",
            "state": "MN",
            "postal_code": "564795280",
            "telephone_number": "218-894-1515",
            "fax_number": "218-894-8767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49725 COUNTY 83",
            "city": "STAPLES",
            "state": "MN",
            "postal_code": "564795280",
            "telephone_number": "218-894-1515",
            "fax_number": "218-894-8767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NYBAKKEN",
        "first_name": "JESSICA",
        "middle_name": "A",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-05-28",
        "last_updated": "2024-02-22",
        "certification_date": "2024-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MN",
            "license": "2322",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staples, MN

Sources for this page

Verify at the official NPI Registry.