NPIMap

Individual provider Active NPI

Lisa M Jackson, ANP

  • Nurse Practitioner
  • Anchorage, AK
National Provider Identifier
1770775827
Registry record updated Oct 18, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
322 Issued in AK
Practice address
6307 Debarr Rd Ste C
Anchorage, AK 99504-1783
Phone
(907) 333-7425
Fax
(907) 333-7719
NPI assigned
Aug 13, 2007
Last updated
Oct 18, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 322 AK Primary

Addresses

Primary practice location

6307 Debarr Rd Ste C
Anchorage, AK 99504-1783

Mailing address

6307 Debarr Rd Ste C
Anchorage, AK 99504-1783
Phone (907) 333-7425

Other identifiers 2

IdentifierTypeStateIssuer
1730113739OtherAKGROUP NPI
NP6817MedicaidAK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080123000103 AK Practitioner - Nurse Practitioner 0941394233 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Soldotna Family Practice LLCGroup PAC ID 4688039654, 4 clinicians

Practice addresses (Care Compare)

1389 Huffman Park Dr
Suite 202
Anchorage, AK 99515-3534
Phone (907) 212-3420

44604 Sterling Hwy
Suite D
Soldotna, AK 99669-7962
Phone (907) 420-0585

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1008AKMDDental Hygienist
322AKMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services- Washington CurrentSince Dec 6, 2024 Accepting new patients
Providence Health & Services-Washington CurrentSince Dec 6, 2024 Accepting new patients

Locations

1389 Huffman Park Dr
Ste 202
Anchorage, AK 99515
Phone (907) 212-3420

3831 Piper St
Ste S220
Anchorage, AK 99508
Phone (907) 212-3420

6307 Debarr Rd
Ste C
Anchorage, AK 99504
Phone (907) 333-7425

920 Compassion Cir
Anchorage, AK 99504
Phone (907) 212-9200

Interoperability endpoints

  • Direct secure messaging: ljackson80625@ak.providencedirect.org

Organizations & group practices 3

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.

Hospital & facility affiliations 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1186963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192665600000",
    "number": "1770775827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6307 DEBARR RD STE C",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995041783",
            "telephone_number": "907-333-7425",
            "fax_number": "907-333-7719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6307 DEBARR RD STE C",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995041783",
            "telephone_number": "907-333-7425",
            "fax_number": "907-333-7719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "LISA",
        "middle_name": "M",
        "credential": "ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-13",
        "last_updated": "2007-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AK",
            "license": "322",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1730113739",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NP6817",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Anchorage, AK

Sources for this page

Verify at the official NPI Registry.