KARISSA KEAGAN JACKSON ACNPC-AG
NPI 1164055109
Nurse Practitioner - Acute Care in Park City, UT

Q: What is Karissa Jackson's NPI number?

The NPI number for Karissa Jackson is 1164055109. It was assigned to this individual provider in the NPPES registry on February 18, 2020. The provider is also known as Karissa Keagan Jungerman.

Q: What is Karissa Jackson's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Acute Care, with taxonomy code 363LA2100X.

Q: When was this NPI record last updated?

The NPPES record for Karissa Jackson was last updated on June 2, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.

Active since February 18, 2020PECOS Enrolled

1776 PARK AVE STE 211, PARK CITY, UT 84060(385) 464-3980(385) 464-3990 Get Directions Write a Review

NPPES record last updated: June 2, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Oct 13, 2020, Sep 14, 2020, Feb 18, 2020 (3 updates tracked since 2020).

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About Karissa Keagan Jackson Acnpc-ag NPPES

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

KARISSA KEAGAN JACKSON ACNPC-AG (NPI 1164055109) is an individual acute care provider in Park City, Utah, licensed in Utah (7120828-4405) and active in the NPI registry since February 2020. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1164055109

Entity TypeIndividualFemale

Primary Taxonomy363LA2100X

Provider Legal NameKARISSA KEAGAN JACKSONCredential: ACNPC-AG

Location Address1776 PARK AVE STE 211Park City, UT 84060-5148

Mailing Address1776 Park Ave Ste 211Park City, UT 84060-5148 · (385) 464-3980 · Fax (385) 464-3990

Phone(385) 464-3980

Fax(385) 464-3990

Sole ProprietorNo

Enumeration DateFebruary 18, 2020

Last NPPES UpdateJune 2, 20243 updates tracked since enumeration

NPPES CertifiedMarch 8, 2023

✔ NPI 1164055109 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Acute CarePhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LA2100X

License✔ Licensed in UT · 7120828-4405

1776 PARK AVE STE 211, Park City, UT 84060

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Other Names 1

Former Name (1)Karissa Keagan Jungerman

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Karissa Keagan Jackson Acnpc-ag 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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 84060 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

$84.41 typical visit price

range $54.34 – $166.03

Typical copayment $21.10 (range $13.58 – $41.50)

Most-billed visit code 99203

Established Patient

$96.35 typical visit price

range $17.23 – $135.20

Typical copayment $24.08 (range $4.30 – $33.80)

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

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

APOLONIA G. SILVA FNP

Nurse Practitioner (Family)

1776 PARK AVE STE 211
PARK CITY, UT 84060

Summit County (385) 464-3980

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 Karissa Jackson's NPI number?

The NPI number for Karissa Jackson is 1164055109. It was assigned to this individual provider in the NPPES registry on February 18, 2020. The provider is also known as Karissa Keagan Jungerman.

Where is Karissa Jackson located?

Karissa Jackson practices at 1776 Park Ave Ste 211, Park City, UT 84060. The listed phone number is (385) 464-3980.

What is Karissa Jackson's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Acute Care, with taxonomy code 363LA2100X.

Is Karissa Jackson enrolled in Medicare?

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

When was this NPI record last updated?

The NPPES record for Karissa Jackson was last updated on June 2, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.