Active NPI
Judy Jackson
- Licensed Practical Nurse
- Portland, OR
National Provider Identifier
1407569718
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 201408689LPN
- Practice address
- 745 NE 122ND Ave
Portland, OR 97230-2001 - Phone
- (503) 252-0241
- NPI assigned
- Jan 2, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 201408689LPN | OR | Primary |
Addresses
Primary practice location
745 NE 122ND Ave
Portland, OR 97230-2001
Mailing address
745 NE 122ND Ave
Portland, OR 97230-2001
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000 | Other | OR | NONE OBTAINED |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | judy.jackson@prestigecare.com |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 201408689LPN | OR | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1672617600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1672617600000",
"number": "1407569718",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "745 NE 122ND AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972302001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "745 NE 122ND AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972302001",
"telephone_number": "503-252-0241"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "JUDY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-01-02",
"last_updated": "2023-01-02",
"certification_date": "2023-01-02",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "OR",
"license": "201408689LPN",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NONE OBTAINED",
"identifier": "000000",
"state": "OR"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "judy.jackson@prestigecare.com",
"affiliation": "N",
"address_1": "745 NE 122nd Ave",
"city": "Portland",
"state": "OR",
"country_code": "US",
"postal_code": "972302001",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.