Chau N. Jackson, AGPCNP-BC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

71007563A Issued in IN

Practice address

1700 E 38TH St
Marion, IN 46953-4568

Phone

(765) 674-3321

Fax

(765) 677-5167

NPI assigned

Oct 12, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in IN

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1507766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695686400000",
    "number": "1336650795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 E 38TH ST",
            "city": "MARION",
            "state": "IN",
            "postal_code": "469534568",
            "telephone_number": "765-674-3321",
            "fax_number": "765-677-5167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 E 38TH ST",
            "city": "MARION",
            "state": "IN",
            "postal_code": "469534568",
            "telephone_number": "765-674-3321",
            "fax_number": "765-677-5167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CHAU",
        "middle_name": "N.",
        "credential": "AGPCNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-12",
        "last_updated": "2023-09-26",
        "certification_date": "2023-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IN",
            "license": "71007563A",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "IN",
            "license": "71007563A",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "IN",
            "license": "71007563A",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71007563A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "APN PRESCRIPTIVE AUTHORITY",
            "identifier": "71007563A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGISTERED NURSE",
            "identifier": "28199163A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CSR-PRESCRIPTIVE AUTHORITY",
            "identifier": "71007563B",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ireland Dental
• Heather Ireland X
• Charles C. Isom, MA,CRC
• Madina Iusupova, MD
• Addison Jackey, RBT
• Leslie Jackson, OTD, OTR/L
• Logan Jackson, RBT
• Tracy Jackson, NP
• Karen J Jacobs, D.O.
• Mary E Jacobs, ATC, LAT

• Nurse Practitioner in Marion, IN
• Providers in Marion, IN by specialty
• Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.