Individual provider Active NPI

Jessie Hoak, ACNS-BC

  • Clinical Nurse Specialist
  • San Angelo, TX
National Provider Identifier
1790065936
Registry record updated Aug 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Nurse SpecialistTaxonomy code 364S00000X
License
718752 Issued in TX
Practice address
3605 Executive Dr
San Angelo, TX 76904-6884
Phone
(325) 245-4000
Fax
(325) 245-4615
NPI assigned
Aug 19, 2011
Last updated
Aug 19, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Nurse Specialist 364S00000X 718752 TX Primary

Addresses

Primary practice location

3605 Executive Dr
San Angelo, TX 76904-6884

Mailing address

PO Box 689022
Franklin, TN 37068-9022
Phone (615) 465-3194

Other identifiers 1

IdentifierTypeStateIssuer
PENDINGMedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111007000561 TX Practitioner - Certified Clinical Nurse Specialist (CNS) 9739351180 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Specialist

State licenses

LicenseStateTypeSpecialty
718752TXMDClinical Nurse Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Regional Employee Assistance Program Inc CurrentSince Aug 8, 2011 Accepting new patients
Regional Employee Assistance Program Inc CurrentSince Aug 8, 2011 Accepting new patients
Regional Employee Assistance Program Inc Current Accepting new patients

Locations

3501 Knickerbocker Rd
San Angelo, TX 76904
Phone (325) 947-6361

3605 Executive Dr
San Angelo, TX 76904
Phone (325) 949-9555

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1313712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1313712000000",
    "number": "1790065936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 689022",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370689022",
            "telephone_number": "615-465-3194",
            "fax_number": "615-465-2875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3605 EXECUTIVE DR",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769046884",
            "telephone_number": "325-245-4000",
            "fax_number": "325-245-4615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOAK",
        "first_name": "JESSIE",
        "credential": "ACNS-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-19",
        "last_updated": "2011-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364S00000X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist",
            "state": "TX",
            "license": "718752",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Angelo, TX

Sources for this page

Verify at the official NPI Registry.