KARISSA KEAGAN JACKSON (NPI# 1164055109) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164055109 |
| Entity Type | Individual |
| Full Name | KARISSA KEAGAN JACKSON |
| Other Name | KARISSA KEAGAN JUNGERMAN |
| Credential | ACNPC-AG |
| Practice Address |
5171 S Cottonwood St Ste 950 Murray UT 84107-5713 |
| Practice Telephone | 8015079555 |
| Practice Fax Number | 8015079550 |
| Mailing Telephone | 8015079555 |
| Mailing Fax Number | 8015079550 |
| Enumeration Date | 2020-02-18 |
| Last Update Date | 2020-10-13 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LA2100X |
Nurse Practitioner Specialization: Acute Care |
7120828-4405 | UT | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 5121 S Cottonwood St, Murray, UT 841075701 | 8015075555 |
| Street Address |
5171 S COTTONWOOD ST STE 950 |
| City | MURRAY |
| State | UT |
| Zip Code | 84107-5713 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083704688 | Paul Andrew House | Neurological Surgery | 5171 S Cottonwood St Ste 950, Murray, UT 84107-5713 | 2006-10-13 |
| 1487173928 | Holly Cushing | Physician Assistant | 5171 S Cottonwood St Ste 950, Murray, UT 84107 | 2017-09-15 |
| 1194083915 | Nam Keun Yoon | Neurological Surgery | 5171 S Cottonwood St Ste 950, Murray, UT 84107-5713 | 2012-04-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902410517 | Brielle Nicole Poulter | Student in an Organized Health Care Education/Training Program | 345 East 4500 So #260, Murray, UT 84107 | 2020-09-01 |
| 1467016592 | Ashlee Brown | Social Worker | C-134, 5284 Commerce Drive, Murray, Murray, UT 84107 | 2019-04-24 |
| 1568940633 | Samantha Duff | Occupational Therapist | 5770 S Fashion Blvd, Bldg 5 Ste 201, Murray, UT 84107 | 2018-08-01 |
| 1881185247 | Derek John Sharp | Occupational Therapist | 5770 S Fashion Blvd, Bldg #5, Suite 210, Murray, UT 84107 | 2018-05-22 |
| 1093223091 | Erin Nicole Hill | Counselor | 345 East 4500 South Suite 260, Murray, UT 84107 | 2018-01-12 |
| 1588171219 | Nicole Danielle Jensen | Counselor | 345 East 4500 South, Suite 260, Murray, UT 84107 | 2018-01-03 |
| 1043725799 | Greater Endodontics LLC | Dentist | 5334 South Woodrow Street, Suite 201, Salt Lake City, UT 84107 | 2017-12-04 |
| 1043739667 | Karyn K Hodge | Audiologist | 4500 So. 777. E. Ste #110, Murray, UT 84107 | 2017-09-14 |
| 1912426750 | Brandon C Burton | Specialist/Technologist, Other | Cta Community Supports 4444 S, 700 E Suite 203, Salt Lake City, UT 84107 | 2017-09-13 |
| 1396261152 | Megan Lehane Delano | Plastic Surgery | 5169 Cottonwood St Ste 420, Murray, UT 84107 | 2017-08-14 |
| Find all providers in zip 84107 | ||||
| Taxonomy Code | 363LA2100X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Acute Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831691393 | Sandra Lee Stoker | Nurse Practitioner | Intermountain Medical Center - Ricu, 5121 S. Cottonwood St., Bldg. 5, Level 5, Murray, UT 84157 | 2018-03-01 |
| 1003162215 | Michael Christensen | Nurse Practitioner | 5802 S 900 E Unit 1, Murray, UT 84121-1644 | 2012-07-25 |
| 1740583863 | Jodi M Olson | Nurse Practitioner | 308 E 4500 S Ste 175, Murray, UT 84107-3977 | 2010-12-11 |
| 1447425897 | Jennifer Abigale Jurynec | Nurse Practitioner | 5121 South Cottonwood St., Murray, UT 84157 | 2008-04-28 |
| 1255309506 | Jessica Lynn Gargus | Nurse Practitioner | 1210 Johnson Blvd Ste 3, Murray, KY 42071-2973 | 2006-03-11 |
| 1497389233 | Amber Lauren Ashby | Nurse Practitioner | 300 S 8th St Ste 182w, Murray, KY 42071-2444 | 2020-03-02 |
| 1871138313 | Cassandra J. Garcia | Nurse Practitioner | 5121 S Cottonwood St, Murray, UT 84107 | 2019-11-07 |
| 1003462482 | Kristy Bentley | Nurse Practitioner | 5121 S Cottonwood St, Murray, UT 84107-5701 | 2019-08-12 |
| 1275188468 | Florin Butuc | Nurse Practitioner | 5121 S Cottonwood St, Murray, UT 84107-5701 | 2019-08-05 |
| 1588224604 | John T Michael | Nurse Practitioner | 5121 S Cottonwood St, Murray, UT 84107-5701 | 2019-06-20 |
| Find all providers in MURRAY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.