Marley Jackson, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

2025018317 Issued in MO

Practice address

70 Jungermann Cir Ste 300
Saint Peters, MO 63376-1637

Phone

(636) 916-7060

NPI assigned

Jul 7, 2025

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MO

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

Specialty

Nurse Practitioner

Education

Other, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Fairview Heights Medical Group SCGroup PAC ID 6800784083, 448 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Barnes-Jewish St Peters Hospital Hospital, Saint Peters, MO, CCN 260191

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Nurse Practitioner

Practice roles

Locations

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.

• Fairview Heights Medical Group SC

  • Multi-Specialty Clinic/Center
  • Saint Louis, MO
  • NPI 1679503668
  Medicare reassignment Care Compare group NPD
• Fairview Heights Medical Group SC

  dba BJC Medical Group of Illinois

  • Multi-Specialty Clinic/Center
  • Saint Louis, MO
  • NPI 1073022000
  NPD
• Physician Groups LC

  • Multi-Specialty Clinic/Center
  • Saint Louis, MO
  • NPI 1285664268
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Barnes Jewish St Peters Hospital Inc

  dba Barnes-Jewish St Peters Hospital

  • General Acute Care Hospital
  • Saint Peters, MO
  • NPI 1144238908
  Care Compare affiliation

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

{
    "created_epoch": "1751846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757980800000",
    "number": "1730079310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 959354",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631959354",
            "telephone_number": "636-916-7060",
            "fax_number": "636-916-9421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "70 JUNGERMANN CIR STE 300",
            "city": "SAINT PETERS",
            "state": "MO",
            "postal_code": "633761637",
            "telephone_number": "636-916-7060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MARLEY",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-07-07",
        "last_updated": "2025-09-16",
        "certification_date": "2025-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MO",
            "license": "2025018317",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "70 Jungermann Cir Ste 300",
            "city": "Saint Peters",
            "state": "MO",
            "country_code": "US",
            "postal_code": "633761637",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Majdee Islam, M.D.
• J Mandava LLC
• J. Kevin McGraw D.D.S., P.C.
• Jack W. Haney, D.D.S., P.C. (Excellence In Dentistry)
• Kasey Jackson, MA, LPC
• James Leland Jacob, O.D.
• Aimee Jacobs, O.D.
• Holly Jacobs, LPC
• Brittany Ann Jaecques, PHARMD
• James a. Kopfensteiner, DDS LLC (St. Charles County Periodontics)

• Nurse Practitioner in Saint Peters, MO
• Providers in Saint Peters, MO by specialty
• Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2025; 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.