MRS. POLLY REBECCA JACKSON (AG-ACNP) – Acute Care Nurse Practitioner, NPI 1790150688

Acute Care Nurse Practitioner

MRS. POLLY REBECCA JACKSON (AG-ACNP) is a healthcare provider. based in Washington, Missouri. specializing in Acute Care Nurse Practitioner. They hold the professional credentials AG-ACNP. They hold a License No. 2015041436 (MO). The NPI Number for MRS. POLLY REBECCA JACKSON (AG-ACNP) is 1790150688

Main info

Female

11 Years Of Experience

Accepts Medicare Assignment

Name

MRS. POLLY REBECCA JACKSON (AG-ACNP)

NPI

1790150688

Phone

(636) 390-4161

Address

4875 N 4 MILE RD

Enumeration Date

3 December 2015

Last Update Date

25 October 2022

Doctor Profile

Medical School Name

OTHER

Secondary Phone

6362398231

Graduation Year

2015 (11 years ago)

PAC ID

3476845405

Group Practice PAC ID

3577630540

Professional Enrollment ID

I20160712000500

Data current as of

20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience44

Completeness75

Years active:10State licenses:1Digital endpointsOther names

Provider Addresses for MRS. POLLY REBECCA JACKSON (AG-ACNP)

4875 N 4 MILE RD
WASHINGTON, MO 630903931
Phone: (636) 390-4161
Type: Mailing
615 S New Ballas Rd
Saint Louis, MO 631418221
Phone: (314) 251-0175
Type: Location
901 E 5TH ST
WASHINGTON, MO 630903127
Phone: (636) 239-8231
Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 63090)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 3577630540View full group profile

Name	Specialty	State
JAYA PARKER (MD)	Internal Medicine	MO
DR. SHANNON ERIN WITTY (M.D.)	Family Practice, Hospitalist	IL
RASHID MAHMOOD QURESHI (MD)	Internal Medicine	MO
LAURA JEAN WEITZEL (MD)	Internal Medicine, Hospitalist	MO
DR. SOHAIL GULZAR (M.D.)	Internal Medicine	MO
DR. BRIAN MICHAEL FISHMAN (D.O., M.S.)	Hospitalist, Internal Medicine	MO
ANOUSHIRAVAN HAKIM (M.D.)	Internal Medicine, Hospitalist, Internal Medicine	MO
DR. ANDREA RAMOS RICHARDS (MD)	Family Practice	MO
LAWRENCE PRABLEK (MD)	Internal Medicine, Hospitalist	MO
TAMMY SUE JUERGENS (FNP)	Nurse Practitioner	MO

Reviews

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Frequently asked questions

What NPI should I save for MRS. POLLY REBECCA JACKSON (AG-ACNP)?

Save NPI 1790150688 if you need a stable reference for MRS. POLLY REBECCA JACKSON (AG-ACNP).

Does this profile mean MRS. POLLY REBECCA JACKSON (AG-ACNP) is currently active?

Yes — MRS. POLLY REBECCA JACKSON (AG-ACNP) appears active in the national provider directory.

What does MRS. POLLY REBECCA JACKSON (AG-ACNP) treat or focus on?

Patients typically see MRS. POLLY REBECCA JACKSON (AG-ACNP) under the specialty Acute Care Nurse Practitioner. Clinical services aligned with this taxonomy classification.

What location shows for MRS. POLLY REBECCA JACKSON (AG-ACNP)?

We surface Washington, Missouri for MRS. POLLY REBECCA JACKSON (AG-ACNP) based on available NPPES addresses.

Is this NPI for an individual or an organization?

This listing corresponds to an Individual Provider.