Jacqueline R Pederson, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

53-80318 Issued in KS

Practice address

800 Ravenhill Dr Ste 100&107
Atchison, KS 66002-9204

Phone

(913) 367-7300

Fax

(913) 674-2030

NPI assigned

Jul 11, 2021

Last updated

Mar 17, 2026By the provider in NPPES

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 identifiers 3

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in KS

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, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Amberwell Atchison AssociationGroup PAC ID 2466363858, 54 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Amberwell Atchison Association

  dba Amberwell Atchison

  • Critical Access Hospital
  • Atchison, KS
  • NPI 1932151487
  Medicare reassignment Care Compare group NPD
• Amberwell Atchison Association

  dba Amberwell Atchison Professional Services

  • Family Medicine Physician
  • Atchison, KS
  • NPI 1528450913
  NPD
• Amberwell Atchison Association

  dba Herington Clinic

  • Rural Health Clinic/Center
  • Herington, KS
  • NPI 1700669819
  NPD
• Amberwell Atchison Association

  dba Amberwell Horton Clinic

  • Rural Health Clinic/Center
  • Horton, KS
  • NPI 1346873502
  NPD (past)
• Amberwell Atchison Association

  dba Amberwell Occupational Health

  • Occupational Medicine Physician
  • Atchison, KS
  • NPI 1609244508
  NPD (past)
• Amberwell Atchison Association

  dba Amberwell Eighth Street Clinic

  • Rural Health Clinic/Center
  • Atchison, KS
  • NPI 1740881929
  NPD (past)
• Amberwell Atchison Association

  dba Amberwell Lansing Clinic

  • Rural Health Clinic/Center
  • Lansing, KS
  • NPI 1780391409
  NPD (past)

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

{
    "created_epoch": "1625961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773705600000",
    "number": "1922670926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 RAVENHILL DR",
            "city": "ATCHISON",
            "state": "KS",
            "postal_code": "660029204",
            "telephone_number": "913-367-2131",
            "fax_number": "913-674-2023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 RAVENHILL DR STE 100&107",
            "city": "ATCHISON",
            "state": "KS",
            "postal_code": "660029204",
            "telephone_number": "913-367-7300",
            "fax_number": "913-674-2030"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1903 Euclid Ave",
            "address_purpose": "LOCATION",
            "city": "Horton",
            "state": "KS",
            "postal_code": "664391238",
            "country_code": "US",
            "telephone_number": "785-486-2468",
            "fax_number": "785-486-2371",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "311 W Locust St",
            "address_purpose": "LOCATION",
            "city": "Troy",
            "state": "KS",
            "postal_code": "660875252",
            "country_code": "US",
            "telephone_number": "785-985-3504",
            "fax_number": "785-985-3813",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1004 Progress Dr Ste 180&145",
            "address_purpose": "LOCATION",
            "city": "Lansing",
            "state": "KS",
            "postal_code": "660436326",
            "country_code": "US",
            "telephone_number": "913-297-3215",
            "fax_number": "913-297-2732",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "801 Atchison St",
            "address_purpose": "LOCATION",
            "city": "Atchison",
            "state": "KS",
            "postal_code": "660022352",
            "country_code": "US",
            "telephone_number": "913-367-5020",
            "fax_number": "913-367-1089",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PEDERSON",
        "first_name": "JACQUELINE",
        "middle_name": "R",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-11",
        "last_updated": "2026-03-17",
        "certification_date": "2026-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KS",
            "license": "53-80318",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "016289096",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "420100370",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30004760070001",
            "state": "KS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "provider@amberwellhealth.org",
            "affiliation": "N",
            "endpointDescription": "Amberwell Atchison",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "800 Raven Hill Drive",
            "city": "Atchison",
            "state": "KS",
            "country_code": "US",
            "postal_code": "66002",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jason Palikij, PHARMD
• Eric J Parks, LCMFT
• Jack Neil Parsons, CRNA
• Amish H Patel, D.D.S.
• Paul a. Moccia, O.D., P.a.
• Heather Dawn Perkins
• Caitlin B Perry, APRN
• Person First Case Management Co
• Kimberly Ann Peterson, RN
• Sammy Peterson, RN

• Family Nurse Practitioner in Atchison, KS
• Providers in Atchison, KS by specialty
• Family Nurse Practitioner in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 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.