Individual provider Active NPI

Trisha A Jacox, APNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Tomah, WI
National Provider Identifier
1689114712
Registry record updated Apr 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
12203-33 Issued in WI
Practice address
500 E Veterans St
Tomah, WI 54660-3105
Phone
(608) 372-3971
NPI assigned
Mar 8, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 200344-30 WI
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 12203-33 WI Primary

Addresses

Primary practice location

500 E Veterans St
Tomah, WI 54660-3105

Mailing address

N6520 Lumberjack Guy Rd
Black River Falls, WI 54615-5405
Phone (715) 284-9851

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20260520000059 WI Order and Referring Only - Nurse Practitioner 5597234401

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
200344-30WIMDRegistered Nurse
12203-33WIMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Inward Healing Psychiatry LLC Psychiatric/Mental Health Current Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1488931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712102400000",
    "number": "1689114712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N6520 LUMBERJACK GUY RD",
            "city": "BLACK RIVER FALLS",
            "state": "WI",
            "postal_code": "546155405",
            "telephone_number": "715-284-9851",
            "fax_number": "715-284-5107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 E VETERANS ST",
            "city": "TOMAH",
            "state": "WI",
            "postal_code": "546603105",
            "telephone_number": "608-372-3971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOX",
        "first_name": "TRISHA",
        "middle_name": "A",
        "name_prefix": "Mrs.",
        "credential": "APNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-08",
        "last_updated": "2024-04-03",
        "certification_date": "2024-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "200344-30",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WI",
            "license": "12203-33",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tomah, WI

Sources for this page

Verify at the official NPI Registry.