Individual provider Active NPI

Lori Ann Jackson, ARNP

  • Family Nurse Practitioner
  • Bowling Green, KY
National Provider Identifier
1235695677
Registry record updated Feb 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
3012954 Issued in KY
Practice address
990 Wilkinson Trce
Bowling Green, KY 42103-3404
Phone
(270) 781-4043
Fax
(270) 781-0778
NPI assigned
Feb 11, 2019
Last updated
Feb 26, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 26, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 3012954 KY Primary

Addresses

Primary practice location

990 Wilkinson Trce
Bowling Green, KY 42103-3404

Mailing address

201 Park St
Bowling Green, KY 42101-1708
Phone (270) 781-5111

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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

Enrollment IDStateProvider typePAC IDDetails
I20190516001617 KY Practitioner - Nurse Practitioner 5193068005 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Graves Gilbert Clinic PLLCGroup PAC ID 4082511167, 207 clinicians

Practice addresses (Care Compare)

990 Wilkinson Trce
Bowling Green, KY 42103-3404
Phone (270) 781-4043

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3012954KYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Graves Gilbert Clinic PLLC CurrentSince Jan 15, 2025 Accepting new patients
Graves Gilbert Clinic PLLC CurrentSince Jan 15, 2025 Accepting new patients

Locations

201 Park St
Bowling Green, KY 42101
Phone (270) 651-2229

350 Park St
Ste 203
Bowling Green, KY 42101
Phone (270) 781-0075

990 Wilkinson Trce
Bowling Green, KY 42103
Phone (270) 781-4043

Interoperability endpoints

  • Direct secure messaging: lorijackson@ggc.allscriptsdirect.net

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1549843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740528000000",
    "number": "1235695677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 PARK ST",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421011708",
            "telephone_number": "270-781-5111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "990 WILKINSON TRCE",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421033404",
            "telephone_number": "270-781-4043",
            "fax_number": "270-781-0778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "LORI",
        "middle_name": "ANN",
        "credential": "ARNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-02-11",
        "last_updated": "2025-02-26",
        "certification_date": "2025-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3012954",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowling Green, KY

Sources for this page

Verify at the official NPI Registry.