Archia Denise Jackson, REGISTERED NURSE

Primary specialty

Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0808X

License

4704235782 Issued in MI

Practice address

3075 Orchard Vista Dr SE
Grand Rapids, MI 49546-7069

Phone

(989) 493-1964

NPI assigned

Jul 17, 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1752710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752710400000",
    "number": "1952293573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5593 CORYDALIS DR",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486031685",
            "telephone_number": "989-493-1964",
            "fax_number": "989-493-1964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3075 ORCHARD VISTA DR SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495467069",
            "telephone_number": "989-493-1964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ARCHIA",
        "middle_name": "DENISE",
        "credential": "REGISTERED NURSE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-07-17",
        "last_updated": "2025-07-17",
        "certification_date": "2025-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "MI",
            "license": "4704235782",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Darren Robert Jacks, PHARMD
• Kali Mackenzie Jackson-Dieleman, LMSW-C, CAADC-DP
• Diana Jackson-Whitfield, MA/LBSW
• Allen Jackson
• Amy Jackson
• Bruce Arden Jackson II, DDS
• Caitlin Jackson
• Dominique Jackson
• Elizabeth Anne Jackson, PMHNP
• Hayley Jackson, OTD

• Psychiatric/Mental Health Registered Nurse in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Psychiatric/Mental Health Registered Nurse in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.