Angelique Mechelle Jackson, RN, APN-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

16345 Issued in TN

Practice address

1410 Trotwood Ave
Columbia, TN 38401-4901

Phone

(678) 754-7728

NPI assigned

Dec 16, 2011

Last updated

Jan 13, 2014By 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 TX

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

Nurse Practitioner

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

DHHS IHS Phoenix AreaGroup PAC ID 9436325420, 31 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Hopi Health Care Center Hospital, Polacca, AZ, CCN 031305

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner, Registered Nurse

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.

• DHHS IHS Phoenix Area

  dba Hopi Health Care Center

  • Critical Access Hospital
  • Polacca, AZ
  • NPI 1356628028

  TX

  Medicare reassignment Care Compare group NPD
• American Current Care PA

  dba Concentra Urgent Care

  • Urgent Care Clinic/Center
  • Addison, TX
  • NPI 1184805574
  NPD
• Alana Healthcare Pharmacy

  • Home Infusion Therapy Pharmacy
  • Nashville, TN
  • NPI 1144557828
  NPD (past)

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

{
    "created_epoch": "1323993600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1389571200000",
    "number": "1144599366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3425 MAPLE TIMBER DR",
            "city": "ANTIOCH",
            "state": "TN",
            "postal_code": "370135453",
            "telephone_number": "678-754-7728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1410 TROTWOOD AVE",
            "city": "COLUMBIA",
            "state": "TN",
            "postal_code": "384014901",
            "telephone_number": "678-754-7728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ANGELIQUE",
        "middle_name": "MECHELLE",
        "name_prefix": "Ms.",
        "credential": "RN, APN-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-12-16",
        "last_updated": "2014-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "16345",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Ann Ingram, MED
• Priscilla Sarah Ingrum
• Erik J Iversen, M.D.
• J. Cody Higgs Counseling, LLC
• Debra Jacks
• Brian D Jackson, DPM
• Emily Jackson, RN
• Karen Ellis Jackson, RN
• Leigh Anne Jackson, RN
• Sarah Lena Jackson

• Family Nurse Practitioner in Columbia, TN
• Providers in Columbia, TN by specialty
• Family Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2014; 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.