NPIMap

Individual provider Active NPI

Jackie Lynn Myers

  • Nurse Practitioner
  • Duluth, MN
National Provider Identifier
1891547030
Registry record updated Sep 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
11831 Issued in MN
Practice address
502 E 2ND St
Duluth, MN 55805-1913
Phone
(218) 786-4000
NPI assigned
Apr 2, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2024

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 11831 MN Primary

Addresses

Primary practice location

502 E 2ND St
Duluth, MN 55805-1913

Mailing address

400 E 3Rd St
Duluth, MN 55805-1951
Phone (218) 786-8364

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, WI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240920003198 MN Practitioner - Nurse Practitioner 8729529409 Reassigns benefits to 4 organizations
I20240923001505 WI Practitioner - Nurse Practitioner 8729529409 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Duluth Clinic LTDGroup PAC ID 2567374283, 1,135 clinicians

Practice addresses (Care Compare)

730 E 34TH St
Hibbing, MN 55746-2341
Phone (218) 262-5225

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11831MNMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
The Duluth Clinic LTD CurrentSince Sep 9, 2024 Accepting new patients
The Duluth Clinic LTD Current Accepting new patients
Essentia Health Virginia, LLC CurrentSince Sep 9, 2024 Accepting new patients
Deer River Healthcare Center, Inc. CurrentSince Sep 9, 2024 Accepting new patients
The Duluth Clinic, LTD Current Accepting new patients
St. Mary'S Hospital of Superior CurrentSince Jan 1, 2026 Accepting new patients
The Duluth Clinic, LTD. CurrentSince Sep 9, 2024 Accepting new patients
Deer River Healthcare Center, Inc. Current Accepting new patients
Essentia Health Virginia, LLC CurrentSince Sep 9, 2024 Accepting new patients
Deer River Healthcare Center, Inc CurrentSince Sep 9, 2024 Accepting new patients
St. Mary'S Hospital of Superior CurrentSince Sep 9, 2024 Accepting new patients
The Duluth Clinic, LTD Past Accepting new patients
The Duluth Clinic, LTD Past Accepting new patients

Locations

115 10th Ave NE
Deer River, MN 56636
Phone (218) 246-2900

115 10th Ave NE
#A
Deer River, MN 56636
Phone (218) 246-8275

502 E 2nd St
Duluth, MN 55805
Phone (218) 727-8762

400 E 3rd St
Duluth, MN 55805
Phone (218) 722-8364

402 E 2nd St
Duluth, MN 55805
Phone (218) 786-3443

300 W Conan St
Ely, MN 55731
Phone (218) 365-7900

1542 Golf Course Rd
Ste 204
Grand Rapids, MN 55744
Phone (218) 322-4900

730 E 34th St
Hibbing, MN 55746
Phone (218) 262-3425

1101 9th St N
Virginia, MN 55792
Phone (218) 305-0000

901 9th St N
Virginia, MN 55792
Phone (218) 741-3340

3500 Tower Ave
Superior, WI 54880
Phone (715) 392-8281

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 10

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

NPI Registry JSON

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

{
    "created_epoch": "1712016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725926400000",
    "number": "1891547030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 E 3RD ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051951",
            "telephone_number": "218-786-8364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "502 E 2ND ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051913",
            "telephone_number": "218-786-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MYERS",
        "first_name": "JACKIE",
        "middle_name": "LYNN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-02",
        "last_updated": "2024-09-10",
        "certification_date": "2024-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MN",
            "license": "11831",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.