JACKSON TEA MSN, PMHNP-BC
NPI 1477365997
Nurse Practitioner - Psychiatric/Mental Health in Anaheim, CA
About Jackson Tea Msn, Pmhnp-bc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JACKSON TEA MSN, PMHNP-BC (NPI 1477365997) is an individual psychiatric/mental health provider in Anaheim, California, licensed in California (95033550) and active in the NPI registry since January 2025. He is enrolled in Medicare PECOS, maintains 2 additional practice locations, and is a graduate of Other (2025).
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Locations 2
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Jackson Tea Msn, Pmhnp-bc is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 92804 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 7
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
ANAHEIM, CA 92804
ANAHEIM, CA 92804
ANAHEIM, CA 92804
ANAHEIM, CA 92804
ANAHEIM, CA 92804
ANAHEIM, CA 92804
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 Jackson Tea's NPI number?
The NPI number for Jackson Tea is 1477365997. It was assigned to this individual provider in the NPPES registry on January 22, 2025.
Where is Jackson Tea located?
Jackson Tea practices at 1720 W Ball Rd Ste 4C, Anaheim, CA 92804. The listed phone number is (714) 683-1472.
What is Jackson Tea's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.
Is Jackson Tea enrolled in Medicare?
Yes. Jackson Tea is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
What insurance does Jackson Tea accept?
Health plans from HMSA and Providence Health Plan list Jackson Tea as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Jackson Tea was last updated on April 15, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 months 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.
# Jackson Tea, MSN, PMHNP-BC · NPI 1477365997
Psychiatric/Mental Health physician in Anaheim, California. Individual provider, active in the CMS NPPES registry since January 22, 2025.
## Identity
- **NPI:** 1477365997 (Entity type: Individual)
- **Enumerated:** January 22, 2025
- **Primary specialty:** Nurse Practitioner - Psychiatric/Mental Health · taxonomy 363LP0808X
- **State license:** 95033550 (California)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 1720 W BALL RD STE 4C, Anaheim, CA 92804-5591
- **Phone:** (714) 683-1472 · **Fax:** (714) 683-1473
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Medical school:** Other, class of 2025
## Record status
- **NPPES last updated:** April 15, 2025
---
Source: [NPI Profile](https://npiprofile.com/npi/1477365997) · Data from the CMS NPPES public registry.