Angelica Jackson, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA11392 Issued in TX

Practice address

1616 Clear LK Cty Blvd Ste 102
Houston, TX 77062-8069

Phone

(713) 493-1346

NPI assigned

Aug 31, 2015

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

Other names 1

• Angelica Ramirez Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Dermone of North Carolina PA

  • MOHS-Micrographic Surgery Physician
  • Wilmington, NC
  • NPI 1245578921
  NPD (past)
• Vein Specialists of North Carolina, PA

  • Surgery Physician
  • Wilmington, NC
  • NPI 1124225057
  NPD (past)

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

{
    "created_epoch": "1440979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714348800000",
    "number": "1770950305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4706 SABERO LN",
            "city": "LEAGUE CITY",
            "state": "TX",
            "postal_code": "775734893",
            "telephone_number": "951-970-7201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1616 CLEAR LK CTY BLVD STE 102",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770628069",
            "telephone_number": "713-493-1346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ANGELICA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-31",
        "last_updated": "2024-04-29",
        "certification_date": "2024-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": "PA11392",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "0010-05899",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANGELICA",
            "last_name": "RAMIREZ",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Allana Jackson, LPC
• Alvin Jackson
• Amy Anne Jackson, CRNA
• Angela Wendy Jackson, RN
• Angelia Rene Jackson
• Angie Marie Jackson
• Aniya Jackson
• Antoine Jackson
• Audra L Jackson, CRNA
• Britney Jackson, FNT, ANT

• Medical Physician Assistant in Houston, TX
• Providers in Houston, TX by specialty
• Medical Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2024; 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.