Individual provider Active NPI

Lora K Jackson, ARNP

  • Family Nurse Practitioner
  • Port Angeles, WA
National Provider Identifier
1568824191
Registry record updated Feb 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP61059916 Issued in WA
Practice address
243511 Highway 101
Port Angeles, WA 98363-9472
Phone
(360) 452-6252
NPI assigned
Mar 23, 2016
Last updated
Feb 7, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AP61059916 WA Primary
Registered Nurse 163W00000X RN60347928 WA

Addresses

Primary practice location

243511 Highway 101
Port Angeles, WA 98363-9472

Mailing address

243511 Highway 101
Port Angeles, WA 98363-9472
Phone (360) 452-6252

Other practice location 1

Madigan Army Medical Ctr
9040 Jackson Ave
Tacoma, WA 98431-1100
Phone (263) 968-1110

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20200624001451 WA Order and Referring Only - Nurse Practitioner 6204258080

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RN60347928WAMDRegistered Nurse
AP61059916WAMDFamily Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1458691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644192000000",
    "number": "1568824191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "243511 HIGHWAY 101",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983639472",
            "telephone_number": "360-452-6252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "243511 HIGHWAY 101",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983639472",
            "telephone_number": "360-452-6252"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Madigan Army Medical Ctr",
            "address_2": "9040 Jackson Ave",
            "address_purpose": "LOCATION",
            "city": "Tacoma",
            "state": "WA",
            "postal_code": "984311100",
            "country_code": "US",
            "telephone_number": "263-968-1110",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "LORA",
        "middle_name": "K",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-23",
        "last_updated": "2022-02-07",
        "certification_date": "2022-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP61059916",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WA",
            "license": "RN60347928",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Angeles, WA

Sources for this page

Verify at the official NPI Registry.