Annabel Grace Jackson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0110010113 Issued in VA

Practice address

680 Oyster Point Rd Ste 105
Newport News, VA 23606-4570

Phone

(757) 668-4851

NPI assigned

Dec 25, 2023

Last updated

May 1, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Childrens Hospital of the Kings Daughters Inc

  dba CHKD Urgent Care

  • Urgent Care Clinic/Center
  • Chesapeake, VA
  • NPI 1578954590
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1703462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777593600000",
    "number": "1104695774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 CHILDRENS LN",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235071971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "680 OYSTER POINT RD STE 105",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236064570",
            "telephone_number": "757-668-4851"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "817 Volvo Pkwy",
            "address_purpose": "LOCATION",
            "city": "Chesapeake",
            "state": "VA",
            "postal_code": "233202855",
            "country_code": "US",
            "telephone_number": "757-668-4630",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3960 Virginia Beach Blvd Ste 101",
            "address_purpose": "LOCATION",
            "city": "Virginia Beach",
            "state": "VA",
            "postal_code": "234522449",
            "country_code": "US",
            "telephone_number": "757-668-4648",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ANNABEL",
        "middle_name": "GRACE",
        "name_prefix": "Miss",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-12-25",
        "last_updated": "2026-05-01",
        "certification_date": "2026-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110010113",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ivyrehab Sept, LLC (Southeastern Physical Therapy)
• Ivyrehab Sept, LLC (Southeastern Physical Therapy)
• Wilson Iyinbor, PHARM.D
• J. Dewey Willis III, D.D.S., P.C., & Assoc.
• J. F. Foretich, Jr., D.D.S. (a division of Atlantic Dental Care)
• Cara Marie Jackson, D.O.
• Christian Jackson, SLP
• Edward Jackson
• Jason Jackson
• Lacey J Jackson, PHARMD

• Physician Assistant in Newport News, VA
• Providers in Newport News, VA by specialty
• Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.