Andrea Jackson, LAC

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

AC01036 Issued in OR

Practice address

33 NE Kelly Ave
Gresham, OR 97030-7539

Phone

(503) 545-2393

NPI assigned

Feb 14, 2007

Last updated

Jul 8, 2011By the provider in NPPES

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

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Access Acupuncture LLC

  • Acupuncturist
  • Gresham, OR
  • NPI 1477710721
  NPD (past) Authorized official

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

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1310083200000",
    "number": "1518000140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2005 SE 159TH PL",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986834406",
            "telephone_number": "503-545-2393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 NE KELLY AVE",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970307539",
            "telephone_number": "503-545-2393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ANDREA",
        "credential": "LAC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-14",
        "last_updated": "2011-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "OR",
            "license": "AC01036",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maya Iturra, LMFT, LMHC, NCC
• Rachael Anne Iverson, MS CCC-SLP
• Gayla Ann Iwata-Reuyl, PHD
• Lina Melese Iyassu, PMHNP
• J.R. Gregg LLC
• Maria Josephina Jacob
• Johnathon Michael Jacobsen
• Kathryn Jacobsen
• Jade Branch Counseling PLLC
• Sydni Denise Jain-Redmond

• Acupuncturist in Gresham, OR
• Providers in Gresham, OR by specialty
• Acupuncturist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.