NPIMap

Individual provider Active NPI

Tara Leigh Jackson, FNP-BC

  • Family Nurse Practitioner
  • Ansted, WV
National Provider Identifier
1790028082
Registry record updated Apr 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
67047 Issued in WV
Practice address
123 James River & Kanawha Turnpike
Ansted, WV 25812
Phone
(304) 228-6809
Fax
(304) 658-4690
NPI assigned
Apr 4, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 67047 WV Primary

Addresses

Primary practice location

123 James River & Kanawha Turnpike
Ansted, WV 25812

Mailing address

123 James River & Kanawha Turnpike
Ansted, WV 25812
Phone (304) 228-6809

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV, VA, OH3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20131212000343 WV Practitioner - Nurse Practitioner 5395972608 Reassigns benefits to 6 organizations
I20260527002640 VA Practitioner - Nurse Practitioner 5395972608 Reassigns benefits to 1 organization
I20260609004203 OH Practitioner - Nurse Practitioner 5395972608 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Post Acute Telehealth PCGroup PAC ID 9638585391, 63 clinicians
Hcma Consultants IncGroup PAC ID 1456256239, 4 clinicians

Practice addresses (Care Compare)

100 Heartland Dr
Beckley, WV 25801-2655
Phone (304) 256-1650

100 Pkwy Dr
Clarksburg, WV 26301-4357
Phone (304) 624-6401

10797 Seneca TRL S
Lindside, WV 24951-7345
Phone (304) 753-4332

1115 Maplewood Ave
Lewisburg, WV 24901-9728
Phone (304) 645-3076

1263 S George St
Charles Town, WV 25414-4384
Phone (304) 725-6575

135 Southern Dr
Keyser, WV 26726-2010
Phone (304) 788-3415

1802 Harper Rd
Suite 102
Beckley, WV 25801-3376
Phone (304) 252-9211

183 Holbrook Rd
Buckhannon, WV 26201-0029
Phone (304) 472-3280

1924 Glenwood Park Rd
Princeton, WV 24739-7969
Phone (304) 425-8128

198 John Cook Nursing Home Rd
Hinton, WV 25951-5074
Phone (304) 466-0332

20 Wilson Dr
Cameron, WV 26033-2024
Phone (304) 686-3318

3 Merit Dr
Richmond Heights, OH 44143-1457
Phone (216) 261-9600

30 Mon General Dr
Morgantown, WV 26505-2853
Phone (304) 285-2720

3819 Chesterfield Ave
Charleston, WV 25304-2647
Phone (304) 925-4771

3875 E Galbraith Rd
Cincinnati, OH 45236-1514
Phone (513) 793-5222

3889 E Galbraith Rd
Cincinnati, OH 45236-1514
Phone (513) 793-5222

41 Crestview Ter
Bridgeport, WV 26330-1010
Phone (304) 842-7101

456 Autumn Acres Rd
Berkeley Springs, WV 25411-3202
Phone (304) 258-3673

5501 Verulam Ave
Cincinnati, OH 45213-2417
Phone (513) 631-1310

712 Professional Park Dr
Summersville, WV 26651-2000
Phone (304) 872-7600

8055 Addison Rd
Masury, OH 44438-1204
Phone (330) 448-2547

859 Days Dr
Sutton, WV 26601-6255
Phone (304) 765-2861

Hospital & facility affiliations

  • Charleston Area Medical Center Hospital, Charleston, WV, CCN 510022
  • Raleigh General Hospital Hospital, Beckley, WV, CCN 510070

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Hospice of Southern West Virginia, Inc CurrentSince Mar 9, 2020 Accepting new patients
Charleston Diabetes & Endocrine Consultants, PLLC Current Accepting new patients
Post Acute Telehealth PC Family CurrentSince Feb 11, 2026 Accepting new patients
Hospice of Southern WV Dba Palliative Care of Southern West Virginia Family Past Accepting new patients

Locations

1619 Stanaford Rd
Ste 226
Beckley, WV 25801

456 Cranberry Dr
Beckley, WV 25801
Phone (304) 255-6404

3100 Maccorkle Ave SE
Ste 810
Charleston, WV 25304
Phone (304) 351-3961

Organizations & group practices 8

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.

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1365033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1365033600000",
    "number": "1790028082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 JAMES RIVER & KANAWHA TURNPIKE",
            "city": "ANSTED",
            "state": "WV",
            "postal_code": "25812",
            "telephone_number": "304-228-6809",
            "fax_number": "304-658-4690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 JAMES RIVER & KANAWHA TURNPIKE",
            "city": "ANSTED",
            "state": "WV",
            "postal_code": "25812",
            "telephone_number": "304-228-6809",
            "fax_number": "304-658-4690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "TARA",
        "middle_name": "LEIGH",
        "name_prefix": "Ms.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-04",
        "last_updated": "2013-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WV",
            "license": "67047",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ansted, WV

Sources for this page

Verify at the official NPI Registry.