MEDICARE: KARISSA KEAGAN JACKSON ACNPC-AG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	7120828-4405	UT

General Provider Information

NPI Number	:	1164055109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARISSA KEAGAN JACKSON ACNPC-AG

Provider Business Mailing Address
First Line	:	1776 PARK AVE STE 211
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84060-5148
Country	:	US
Telephone Number	:	385-464-3980
Fax Number	:	385-464-3990

Provider Business Practice Location Address
First Line	:	1776 PARK AVE STE 211
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84060-5148
Country	:	US
Telephone Number	:	385-464-3980
Fax Number	:	385-464-3990

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/18/2020
Last Update Date	:	06/02/2024

Similar Medicare Providers

1861677825 — APOLONIA G. SILVA FNP
Practice Location Address:

1776 PARK AVE STE 211
PARK CITY, UT
84060-5148

Practice Phone: 385-464-3980
Practice Fax: 385-464-3990

1225586852 — PATRICK GENTEMPO JR.
Practice Location Address:

1776 PARK AVE STE 4-217
PARK CITY, UT
84060-5148

Practice Phone: 201-345-3370
Practice Fax:

1467121426 — GLASS HOUSE RECOVERY
Practice Location Address:

8318 FORREST ST STE 100
ELLICOTT CITY, MD
21043-5148

Practice Phone: 410-970-4842
Practice Fax:

1932107497 — DR. BERNARD ALLEN MILSTEIN MD
Practice Location Address:

1100 GULF FWY S STE 114
LEAGUE CITY, TX
77573-5148

Practice Phone: 281-332-3937
Practice Fax:

1033168711 — DR. SEAN A REYHANI D.P.M.
Practice Location Address:

1100 GULF FWY S STE 106
LEAGUE CITY, TX
77573-5148

Practice Phone: 281-554-0111
Practice Fax: 281-332-1787

1942344452 — DR. MILETE CLARK KLINKERMAN O.D.
Practice Location Address:

1100 GULF FWY S STE 114
LEAGUE CITY, TX
77573-5148

Practice Phone: 281-338-4497
Practice Fax:

Directions to “ KARISSA KEAGAN JACKSON ACNPC-AG” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.