Jacqueline Felicia Cannon, APRN, AGPCNP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

5021868 Issued in NC

Practice address

160 Mine Lake CT Ste 200
Raleigh, NC 27615-6417

Phone

(855) 984-5121

NPI assigned

Mar 14, 2025

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

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

Specialty

Nurse Practitioner

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Goshen Medical Center IncorporatedGroup PAC ID 3173434479, 96 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Goshen Medical Center, Incorporated

  • Federally Qualified Health Center (FQHC)
  • Kenansville, NC
  • NPI 1962124974
  Medicare reassignment Care Compare group
• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863

  NC

  Medicare reassignment NPD

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

{
    "created_epoch": "1741910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742774400000",
    "number": "1801696380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 MINE LAKE CT STE 200",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276156417",
            "telephone_number": "919-630-3936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 MINE LAKE CT STE 200",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276156417",
            "telephone_number": "855-984-5121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNON",
        "first_name": "JACQUELINE",
        "middle_name": "FELICIA",
        "credential": "APRN, AGPCNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-03-14",
        "last_updated": "2025-03-24",
        "certification_date": "2025-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NC",
            "license": "5021868",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cannenta Wellness & Counseling Inc
• Katie D Cannizzaro, PT
• Brenda Gail Cannon, BA IN PSYCHOLOGY
• Gregory J Cannon, MD
• Ja'Kyra Tannell Cannon, PTA
• Katherine Clifton Cannon, RD
• Nathalia Kalena Cannon, MS
• Nihan Kaya Cannon, M.D.
• Shelia Cannon
• William Russell Cannon, M.D.

• Gerontology Nurse Practitioner in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Gerontology Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.