Andrea Marie Jackson

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

204935 Issued in ND

Practice address

500 E Front Ave Ste 102
Bismarck, ND 58504-5689

Phone

(701) 975-6400

Fax

(844) 670-8600

NPI assigned

May 29, 2026

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Specialty

Nurse Practitioner

Education

Other, 2026

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1780012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780012800000",
    "number": "1437080124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "830 STAGECOACH CIR",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585038832",
            "telephone_number": "406-672-9856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 E FRONT AVE STE 102",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585045689",
            "telephone_number": "701-975-6400",
            "fax_number": "844-670-8600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ANDREA",
        "middle_name": "MARIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-05-29",
        "last_updated": "2026-05-29",
        "certification_date": "2026-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "ND",
            "license": "204935",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gregory Iwaasa, DPM
• Matthew Iwamoto, MD
• Jennifer Jablonski
• Tayte Jablonski
• Roxanne Jablonsky, RN, BSN, NC-BC
• Jenica J Jackson, PHARMD
• Kennedy Jacob
• Morgan Jacob
• Erika Lynne Jacobs, PT
• Erin Jean Jacobs

• Family Nurse Practitioner in Bismarck, ND
• Providers in Bismarck, ND by specialty
• Family Nurse Practitioner in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2026; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.