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General NPI Number Information
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NPI Number | 1477405280
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Entity Type | Organization
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Legal Business Name | NISHA JACKSON INC.
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Dates
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Enumeration Date | 02/12/2026
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Last Update Date | 02/12/2026
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Provider Practice Location Address
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Address Line | 2340 S 6TH ST
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City | KLAMATH FALLS
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State | OR
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Zip | 97601-4340
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Country | US
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Telephone | 541-204-4493
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Fax |
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Provider Business Mailing Address
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Address Line | 2040 COMMERCE DR
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City | MEDFORD
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State | OR
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Zip | 97504-9744
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Country | US
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Telephone | 541-930-8545
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Fax |
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Authorized Official
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Title or Position | VP OF BILLING AND CONTRACTING
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Name | KARISSA STULTS
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Credential |
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Telephone | 541-930-8545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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