Karissa Keagan Jackson, ACNPC-AG
Nurse Practitioner, Acute Care in Park City, UT. Individual provider (NPI-1).
NPI number1164055109
StatusActive
Last updated in NPPESJun 2, 2024
Details
- NPI
- 1164055109
- Entity type
- Individual (NPI-1)
- Name
- Karissa Keagan Jackson
- Credential
- ACNPC-AG
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Feb 18, 2020
- Certification date
- Mar 8, 2023
- Last updated
- Jun 2, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LA2100X | Nurse Practitioner, Acute Care | 7120828-4405 | UT | Yes |
Other names
- Karissa Keagan Jungerman (Former Name)
Practice location
1776 Park Ave Ste 211Park City, UT 84060-5148
Phone 385-464-3980 · Fax 385-464-3990
Mailing address
1776 Park Ave Ste 211Park City, UT 84060-5148
Phone 385-464-3980 · Fax 385-464-3990
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