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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

LAURA ELAINE JACKSON MD PHD
NPI 1679385694
Student in an Organized Health Care Education/Training Program in Minneapolis, MN

Active since January 25, 2025PECOS Enrolled
2450 RIVERSIDE AVE, MINNEAPOLIS, MN 55454(612) 672-6000 Get Directions Write a Review

NPPES record last updated: July 6, 2026. Verified against the NPPES registry weekly; last sync: August 23, 2026.

About Laura Elaine Jackson Md Phd NPPES

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

LAURA ELAINE JACKSON MD PHD (NPI 1679385694) is an individual student in an organized health care education/training program in Minneapolis, Minnesota and active in the NPI registry since January 2025. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1679385694
Entity TypeIndividualFemale
Primary Taxonomy390200000X
Provider Legal NameLAURA ELAINE JACKSONCredential: MD PHD
Location Address2450 RIVERSIDE AVEMinneapolis, MN 55454-1450
Mailing Address2917 Edgewood Ave SMinneapolis, MN 55426-3325
Phone(612) 672-6000
Sole ProprietorNo
Enumeration DateJanuary 25, 2025
Last NPPES UpdateJuly 6, 2026
NPPES CertifiedJuly 6, 2026
✔ NPI 1679385694 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
2450 RIVERSIDE AVE, Minneapolis, MN 55454
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Laura Elaine Jackson Md Phd 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.

Other Providers at the Same Location NPPES 20

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

MICHELLE IRENE GRAY
Rehabilitation Practitioner
2450 RIVERSIDE AVE
MINNEAPOLIS, MN 55454
Hennepin County (612) 672-6000
DR. KATHLEEN F SADAK MD
Pediatrics
2450 RIVERSIDE AVE
MINNEAPOLIS, MN 55454
Hennepin County (612) 273-6402
DR. ADMATHA MUTHYALA WINFRED MD
Internal Medicine (Geriatric Medicine)
2450 RIVERSIDE AVE
MINNEAPOLIS, MN 55454
Hennepin County (612) 672-6000
KELLY SCHELLER WILLIAMS
Dietitian, Registered
2450 RIVERSIDE AVE
MINNEAPOLIS, MN 55454
Hennepin County (612) 273-3216
MRS. MARY SUSAN CLIPP CPNP-AC
Nurse Practitioner (Pediatrics, Critical Care)
2450 RIVERSIDE AVE
MINNEAPOLIS, MN 55454
Hennepin County (612) 365-3100
DANIEL TESFAYE KEBED MD
Internal Medicine
2450 RIVERSIDE AVE
MINNEAPOLIS, MN 55454
Hennepin County (612) 672-6000
MS. CHELSEA ANJELICA MIELKE PA-C
Physician Assistant
2450 RIVERSIDE AVE
MINNEAPOLIS, MN 55454
Hennepin County (612) 672-6000
MRS. JESSICA LYNN MCADAM
Nurse Anesthetist, Certified Registered
2450 RIVERSIDE AVE
MINNEAPOLIS, MN 55454
Hennepin County (612) 273-8383

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 Laura Jackson's NPI number?

The NPI number for Laura Jackson is 1679385694. It was assigned to this individual provider in the NPPES registry on January 25, 2025.

Where is Laura Jackson located?

Laura Jackson practices at 2450 Riverside Ave, Minneapolis, MN 55454. The listed phone number is (612) 672-6000.

What is Laura Jackson's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Laura Jackson enrolled in Medicare?

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

When was this NPI record last updated?

The NPPES record for Laura Jackson was last updated on July 6, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 53 days 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.