Angelique Mechelle Jackson, RN, APN-BC
Individual provider Active NPI Family Nurse Practitioner · Columbia, TN
NPI 1144599366 · NPPES record last updated Jan 13, 2014
Key facts
- NPI
- 1144599366
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 16345 (TN)
- Practice address
- 1410 Trotwood Ave
Columbia, TN 38401-4901 - Phone
- (678) 754-7728
- NPI assigned
- Dec 16, 2011
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- DHHS IHS Phoenix Area
Practice addresses (Care Compare)
Highway 264 Milepost
Suite 388
Polacca, AZ 86042-4000
PO Box
4000 Hwy 264 Milepost 388
Polacca, AZ 86042-4000
Hospital & facility affiliations
- Hopi Health Care Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160315002895 | TX | Practitioner - Nurse Practitioner | 3779759220 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner, Registered Nurse
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| American Current Care PA | Current | Accepting new patients | |
| DHHS IHS Phoenix Area | Current |
Accepting new patients | |
| Alana Healthcare Pharmacy | Past | Accepting new patients |
Locations
6413 Lee Hwy
Ste 107
Chattanooga, TN 37421
Phone (423) 225-3358
2531 Elm Hill Pike
Nashville, TN 37214
Phone (615) 284-1843
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 16345 | TN | Yes |
Addresses
Primary practice location
1410 Trotwood Ave
Columbia, TN 38401-4901
Mailing address
3425 Maple Timber Dr
Antioch, TN 37013-5453
Phone (678) 754-7728
Other providers in Columbia, TN
- Elizabeth Ann Ingram
- Priscilla Sarah Ingrum
- Erik J Iversen
- J. Cody Higgs Counseling, LLC
- Debra Jacks
- Brian D Jackson
- Emily Jackson
- Karen Ellis Jackson
- Leigh Anne Jackson
- Sarah Lena Jackson
All providers in Columbia, TN · Family Nurse Practitioner in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 13, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.