Jackson Healthcare Clinic LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

JACKSON HEALTHCARE CLINIC LLC

Practice address

2107 Pike St Ste 3
Parkersburg, WV 26101-6973

Phone

(681) 229-0984

Fax

(681) 229-0985

NPI assigned

Oct 20, 2020

Last updated

Oct 21, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Alisha Jackson, APRN

Title

Owner

Phone

(304) 210-0061

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1603152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603238400000",
    "number": "1639778731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2107 PIKE ST STE 3",
            "city": "PARKERSBURG",
            "state": "WV",
            "postal_code": "261016973",
            "telephone_number": "681-229-0984",
            "fax_number": "681-229-0985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2107 PIKE ST STE 3",
            "city": "PARKERSBURG",
            "state": "WV",
            "postal_code": "261016973",
            "telephone_number": "681-229-0984",
            "fax_number": "681-229-0985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON HEALTHCARE CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-20",
        "last_updated": "2020-10-21",
        "certification_date": "2020-10-21",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "ALISHA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-210-0061",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1215491006",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "jacksonhealthcare2020@gmail.com",
            "affiliation": "N",
            "address_1": "2107 Pike St Ste 3",
            "city": "Parkersburg",
            "state": "WV",
            "country_code": "US",
            "postal_code": "261016973",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Heather M Irvin, MD
• Christine Isaacs, MSW, LICSW
• Kimberly Lynn Isaacs
• Amy J. Isaly, MPT
• Eileen Isner
• Chasady Lynn Jackson, PRSS
• Christina Jackson, MS
• Deanna Lynn Jackson, O.D
• Elisha F Jackson, LSW
• Felicity Dawn Jackson

• Family Nurse Practitioner in Parkersburg, WV
• Providers in Parkersburg, WV by specialty
• Family Nurse Practitioner in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2020; 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.