Angel Jackson

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

123472 Issued in WV

Practice address

400 S Ruffner Rd Ste 11
Charleston, WV 25314-1542

Phone

(304) 720-9595

NPI assigned

Jan 13, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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 and National Provider Directory roles.

• Boone Memorial Homecare, LLC

  • Home Health Agency
  • Danville, WV
  • NPI 1184848970
  NPD

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

{
    "created_epoch": "1673568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785283200000",
    "number": "1407560402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2866 MUDFORK ROAD",
            "city": "VERDUNVILLE",
            "state": "WV",
            "postal_code": "25649",
            "telephone_number": "304-784-0989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 S RUFFNER RD STE 11",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253141542",
            "telephone_number": "304-720-9595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ANGEL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-01-13",
        "last_updated": "2026-07-29",
        "certification_date": "2026-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WV",
            "license": "91990",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "WV",
            "license": "123472",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sibel Islak Mutcali, MD
• Shanna Marie Ison, OTRL
• Barbara Iyanda
• Ramakrishnan S Iyer, MD
• J. Christopher Smith, D.D.S. PLLC
• Brooklyn Jackson
• Carrie L Jackson
• Cassie Jackson
• Christina Mae Jackson
• Chynna Rajae Jackson

• Primary Care Nurse Practitioner in Charleston, WV
• Providers in Charleston, WV by specialty
• Primary Care Nurse Practitioner in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.