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TIFFANY MICHELLE JACKSON APRN, AGNP-C
NPI 1114385374
Nurse Practitioner - Primary Care in Fayetteville, AR

Active since February 03, 2016PECOS Enrolled
12 E APPLEBY RD, SUITE 101, FAYETTEVILLE, AR 72703(479) 463-4444(479) 463-4499 Get Directions Write a Review

NPPES record last updated: August 5, 2016. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Tiffany Michelle Jackson Aprn, Agnp-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TIFFANY MICHELLE JACKSON APRN, AGNP-C (NPI 1114385374) is an individual primary care provider in Fayetteville, Arkansas, licensed in Arkansas (A004646) and active in the NPI registry since February 2016. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1114385374
Entity TypeIndividualFemale
Primary Taxonomy363LP2300X
Provider Legal NameTIFFANY MICHELLE JACKSONCredential: APRN, AGNP-C
Location Address12 E APPLEBY RD, SUITE 101Fayetteville, AR 72703-3901
Mailing Address12 E Appleby Rd, Suite 101Fayetteville, AR 72703-3901 · (479) 463-4444 · Fax (479) 463-4499
Phone(479) 463-4444
Fax(479) 463-4499
Sole ProprietorNo
Enumeration DateFebruary 3, 2016
Last NPPES UpdateAugust 5, 2016
✔ NPI 1114385374 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Primary CarePhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP2300X
License✔ Licensed in AR · A004646
12 E APPLEBY RD, Fayetteville, AR 72703
Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Tiffany Michelle Jackson Aprn, Agnp-c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Tiffany Jackson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Washington Regional Medical System
Same address
Multi-Specialty
12 E APPLEBY RD, WASHINGTON REGIONAL SENIOR CLINIC
Fayetteville, AR 72703
  • Reassigned Medicare billing, Arkansas enrollment
  • Also billed through NPI 1205073657 (Arkansas)
  • 17 clinicians in this Medicare group
NPI 1699731208 (479) 463-4444

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 72703 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$79.72 typical visit price
range $51.36 – $157.74
Typical copayment $19.93 (range $12.84 – $39.43)
Most-billed visit code 99203
Established Patient
$91.63 typical visit price
range $16.16 – $128.77
Typical copayment $22.90 (range $4.04 – $32.19)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 16

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

EMILY J COOMBS APRN
Nurse Practitioner (Adult Health)
12 E APPLEBY RD, SUITE 101
FAYETTEVILLE, AR 72703
Washington County (479) 463-4444
WASHINGTON REGIONAL MEDICAL SYSTEM
Physical Therapist
12 E APPLEBY RD, SUITE 104
FAYETTEVILLE, AR 72703
Washington County (479) 463-6824
ANTOINETTE LYNN HARTMAN APN
Nurse Practitioner
12 E APPLEBY RD, STE 101
FAYETTEVILLE, AR 72703
Washington County (479) 463-4444
LAUREN HAYS
Speech-Language Pathologist
12 E APPLEBY RD, SUITE 104
FAYETTEVILLE, AR 72703
Washington County (479) 463-6824
CHELSEA RUSH THOMPSON AGPCNP-BC
Nurse Practitioner (Gerontology)
12 E APPLEBY RD
FAYETTEVILLE, AR 72703
Washington County (479) 463-4444
STEPHEN B GEMMELL PHD
Psychologist
12 E APPLEBY RD, STE 101
FAYETTEVILLE, AR 72703
Washington County (479) 463-4444
RANDY J SHINN MD
Internal Medicine (Geriatric Medicine)
12 E APPLEBY RD, STE 101
FAYETTEVILLE, AR 72703
Washington County (479) 463-4444
WASHINGTON REGIONAL MEDICAL CENTER
Dentist
12 E APPLEBY RD, SUITE 102
FAYETTEVILLE, AR 72703
Washington County (479) 463-4746

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Tiffany Jackson's NPI number?

The NPI number for Tiffany Jackson is 1114385374. It was assigned to this individual provider in the NPPES registry on February 3, 2016.

Where is Tiffany Jackson located?

Tiffany Jackson practices at 12 E Appleby Rd Suite 101, Fayetteville, AR 72703. The listed phone number is (479) 463-4444.

What is Tiffany Jackson's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Primary Care, with taxonomy code 363LP2300X.

Is Tiffany Jackson enrolled in Medicare?

Yes. Tiffany Jackson is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Tiffany Jackson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Tiffany Jackson reassigns Medicare benefits to Washington Regional Medical System (Fayetteville, AR). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Tiffany Jackson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Tiffany Jackson was last updated on August 5, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.