NPIMap

Individual provider Active NPI

Jakiann Marie Mork, ANP-BC

  • Adult Health Nurse Practitioner
  • Wyoming, MN
National Provider Identifier
1184855587
Registry record updated Aug 3, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
R103401-7 Issued in MN
Practice address
5200 Fairview Blvd
Wyoming, MN 55092-8013
Phone
(651) 982-7893
NPI assigned
Aug 3, 2009
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 3, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X R103401-7 MN Primary

Addresses

Primary practice location

5200 Fairview Blvd
Wyoming, MN 55092-8013

Mailing address

4535 Heights Dr
Columbia Heights, MN 55421-3321
Phone (763) 571-8105

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
I20091020000229 MN Practitioner - Nurse Practitioner 0244377505 Reassigns benefits to 8 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
St Josephs Medical CenterGroup PAC ID 8224948443, 238 clinicians

Practice addresses (Care Compare)

523 N 3Rd St
Brainerd, MN 56401-3054
Phone (218) 829-2861

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1980MNMDAcupuncturist
R103401-7MNMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Clinics Current Accepting new patients
Fairview Express Care CurrentSince Jun 16, 2020 Accepting new patients
Fairview Express Care Current Accepting new patients
Fairview Clinics CurrentSince Jun 16, 2020 Accepting new patients
St. Joseph's Medical Center Current Accepting new patients
Healtheast Medical Research Institute CurrentSince Jun 16, 2020 Accepting new patients
Fairview Health Services Current Accepting new patients
St. Joseph's Medical Center CurrentSince Jun 7, 2021 Accepting new patients
St Joseph's Medical Center CurrentSince Jun 7, 2021 Accepting new patients
Healtheast Medical Research Institute Current Accepting new patients
University of Minnesota Physicians Past Accepting new patients

Locations

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

14101 Fairview Dr
Ste 300
Burnsville, MN 55337
Phone (612) 273-5400

1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860

720 Washington Ave SE
Minneapolis, MN 55414
Phone (612) 883-0649

516 Delaware St SE
Minneapolis, MN 55455
Phone (612) 625-3600

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

909 Fulton St SE
Minneapolis, MN 55455
Phone (612) 273-8383

500 Harvard St SE
Minneapolis, MN 55455
Phone (612) 273-7300

420 Delaware St SE
#126
Minneapolis, MN 55455
Phone (612) 626-2378

2450 Riverside Ave
Minneapolis, MN 55454
Phone (612) 273-7838

400 Stinson Blvd
Fl 2
Minneapolis, MN 55413
Phone (612) 672-2203

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

1575 Beam Ave
Saint Paul, MN 55109
Phone (651) 232-7000

1700 University Ave W
Fl 6
Saint Paul, MN 55104
Phone (651) 232-2273

45 10th St W
Saint Paul, MN 55102
Phone (651) 232-3000

1151 Silver Lake Rd NW
Saint Paul, MN 55112
Phone (612) 706-4500

1925 Woodwinds Dr
Woodbury, MN 55125
Phone (651) 232-0100

5200 Fairview Blvd
Wyoming, MN 55092
Phone (651) 464-4611

Organizations & group practices 15

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.

View all 15

Hospital & facility affiliations 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1249257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1249257600000",
    "number": "1184855587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4535 HEIGHTS DR",
            "city": "COLUMBIA HEIGHTS",
            "state": "MN",
            "postal_code": "554213321",
            "telephone_number": "763-571-8105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5200 FAIRVIEW BLVD",
            "city": "WYOMING",
            "state": "MN",
            "postal_code": "550928013",
            "telephone_number": "651-982-7893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORK",
        "first_name": "JAKIANN",
        "middle_name": "MARIE",
        "credential": "ANP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-08-03",
        "last_updated": "2009-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MN",
            "license": "R103401-7",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wyoming, MN

Sources for this page

Verify at the official NPI Registry.