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NPI Code Detail

MEDICARE: TARA L JACKSON APRN

MEDICARE: TARA L JACKSON APRN
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
1363LF0000XFamily Nurse Practitioner53-75820-112KS
2363LF0000XFamily Nurse Practitioner2012041039MO

General Provider Information

NPI Number : 1184979098
Entity Type Code : Individual
Provider Name (Legal Business Name) : TARA L JACKSON APRN
Provider Business Mailing Address
First Line : 7221 HOLMES RD
Second Line :
City : KANSAS CITY
State : MO
Zip : 64131-1675
Country : US
Telephone Number : 816-276-7410
Fax Number :
Provider Business Practice Location Address
First Line : 4000 CAMBRIDGE ST
Second Line :
City : KANSAS CITY
State : KS
Zip : 66160-8501
Country : US
Telephone Number : 913-588-1227
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2012
Last Update Date : 12/19/2025

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