Angelita Jackson

Key facts

NPI

1578078077

Entity type

Individual (NPI type 1)

Primary specialty

Licensed Practical Nurse 164W00000X

License

290702 (NY)

Practice address

323 Angelo Dr
Montgomery, NY 12549-1627

Phone

(914) 980-7802

NPI assigned

Dec 6, 2017

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 6, 2017.

{
    "created_epoch": "1512518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1512518400000",
    "number": "1578078077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "323 ANGELO DR",
            "city": "MONTGOMERY",
            "state": "NY",
            "postal_code": "125491627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "323 ANGELO DR",
            "city": "MONTGOMERY",
            "state": "NY",
            "postal_code": "125491627",
            "telephone_number": "914-980-7802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ANGELITA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-12-06",
        "last_updated": "2017-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "290702",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Montgomery, NY · Licensed Practical Nurse in New York