Nisha Jackson PC
Nurse Practitioner in Medford, OR. Organization (NPI-2).
NPI number1124499124
StatusActive
Last updated in NPPESJul 31, 2026
Details
- NPI
- 1124499124
- Entity type
- Organization (NPI-2)
- Legal business name
- Nisha Jackson PC
- Organization subpart
- No
- Enumeration date
- Oct 15, 2015
- Certification date
- Jul 31, 2026
- Last updated
- Jul 31, 2026
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PART B SUPPLIER - CLINIC/GROUP PRACTICE
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363L00000X | Nurse Practitioner | 086006299N7 | OR | Yes |
Practice location
3265 Hillcrest Park DrMedford, OR 97504-7657
Phone 541-494-9355 · Fax 541-210-8724
Mailing address
3265 Hillcrest Park DrMedford, OR 97504-7657
Phone 541-494-9355 · Fax 541-494-0945
Authorized official
Karissa Stults
Vp Of Billing And Contracting
5419308545
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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