Mary Tiffany Jackson, FNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

0024195024 Issued in VA

Practice address

1300 Enterprise Dr
Lynchburg, VA 24502-5746

Phone

(434) 845-6045

NPI assigned

Oct 17, 2025

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Mary Tiffany Jackson Other name

Medicare fee-for-service enrollment

Enrolled in VA

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

1 Care Partners LLCGroup PAC ID 1850813254, 13 clinicians

Universal Health CorporationGroup PAC ID 5597912626, 120 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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.

• 1 Care Partners LLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Lynchburg, VA
  • NPI 1205652898
  Medicare reassignment Care Compare group NPD
• Universal Health Corporation

  • Internal Medicine Physician
  • Roanoke, VA
  • NPI 1407117625
  Medicare reassignment Care Compare group NPD
• Pai Participant 1 LLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Chillicothe, OH
  • NPI 1093371312

  Nurse Practitioner, VA

  Medicare reassignment NPD

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

{
    "created_epoch": "1760659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769558400000",
    "number": "1811864655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4110 BALL PARK LOOP",
            "city": "HALIFAX",
            "state": "VA",
            "postal_code": "245582222",
            "telephone_number": "540-312-5256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 ENTERPRISE DR",
            "city": "LYNCHBURG",
            "state": "VA",
            "postal_code": "245025746",
            "telephone_number": "434-845-6045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MARY",
        "middle_name": "TIFFANY",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-10-17",
        "last_updated": "2026-01-28",
        "certification_date": "2026-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "VA",
            "license": "0024195024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "JACKSON",
            "middle_name": "TIFFANY",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Bradley Jackson
• Cerria Jackson, LPC
• Gabrielle K. Jackson, M.D.
• Karen Sydni Jackson, ATC
• Kevin Jackson, DO
• Olivia Jackson, SPECIALIST
• Pamela Sue Jackson, NP
• Rasheedah Jackson, SOCIAL WORKER
• Stephen Jackson
• Tiffany Marie Jackson

• Nurse Practitioner in Lynchburg, VA
• Providers in Lynchburg, VA by specialty
• Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2026; 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.