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  7. NPI Record 1639263486

ANGELA VICTORIA JACKSON RN, MSN
Complete NPI Record 1639263486
Nurse Practitioner - Family in Nashville, TN

NPI Status: Active since October 03, 2006

Contact Information

5201 CHARLOTTE PIKE
NASHVILLE, TN
ZIP 37209
Phone: (615) 222-1900
Fax: (615) 222-1917

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Provider Last Name Legal Name
  4. Provider First Name
  5. Provider Middle Name
  6. Provider Credential Text
  7. Provider First Line Business Mailing Address
  8. Provider Business Mailing Address City Name
  9. Provider Business Mailing Address State Name
  10. Provider Business Mailing Address Postal Code
  11. Provider Business Mailing Address Country Code If outside U S
  12. Provider Business Mailing Address Telephone Number
  13. Provider First Line Business Practice Location Address
  14. Provider Business Practice Location Address City Name
  15. Provider Business Practice Location Address State Name
  16. Provider Business Practice Location Address Postal Code
  17. Provider Business Practice Location Address Country Code If outside U S
  18. Provider Business Practice Location Address Telephone Number
  19. Provider Business Practice Location Address Fax Number
  20. Provider Enumeration Date
  21. Last Update Date
  22. Provider Gender Code
  23. Healthcare Provider Taxonomy Code 1
  24. Provider License Number 1
  25. Provider License Number State Code 1
  26. Healthcare Provider Primary Taxonomy Switch 1
  27. Other Provider Identifier 1
  28. Other Provider Identifier Type Code 1
  29. Other Provider Identifier State 1
  30. Other Provider Identifier Issuer 1
  31. Other Provider Identifier 2
  32. Other Provider Identifier Type Code 2
  33. Other Provider Identifier State 2
  34. Other Provider Identifier 3
  35. Other Provider Identifier Type Code 3
  36. Other Provider Identifier State 3
  37. Other Provider Identifier Issuer 3
  38. Other Provider Identifier 4
  39. Other Provider Identifier Type Code 4
  40. Other Provider Identifier State 4
  41. Other Provider Identifier Issuer 4
  42. Is Sole Proprietor
  43. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1639263486. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1639263486
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 1
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
The last name of the provider. If the provider is an individual, this is the legal name.
Provider First Name: ANGELA
The first name of the provider, if the provider is an individual.
Provider Middle Name: VICTORIA
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider Credential Text: RN, MSN
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Provider First Line Business Mailing Address: 700 CHIEF EDDIE HOFFMAN HWY
Provider Business Mailing Address City Name: BETHEL
Provider Business Mailing Address State Name: AK
The date the provider was assigned a unique identifier (assigned an NPI).
Provider Business Mailing Address Postal Code: 99559
The date that a record was last updated or changed.
Provider Business Mailing Address Country Code If outside U S : US
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Provider Business Mailing Address Telephone Number: 9075436000
The first name of the authorized official.
Provider First Line Business Practice Location Address: 5201 CHARLOTTE PIKE
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: NASHVILLE
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: TN
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 372093320
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 6152221900
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 6152221917
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 10/3/2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 7/9/2020
The date that a record was last updated or changed.
Provider Gender Code: F
The code designating the provider’s gender if the provider is a person.
Healthcare Provider Taxonomy Code 1: 363LF0000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: 0000008302
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1: TN
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: Y
Other Provider Identifier 1: 4321158
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 1: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1: TN
Other Provider Identifier Issuer 1: BLUE CROSS-BLUE SHIELD
Other Provider Identifier 2: 3349491
The middle name of the provider, if the provider is an individual.
Other Provider Identifier Type Code 2: 05
The name prefix or salutation of the provider if the provider is an individual; for example, Mr., Mrs., or Corporal.
Other Provider Identifier State 2: TN
The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
Other Provider Identifier 3: 4301404
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 3: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 3: TN
Other Provider Identifier Issuer 3: BCBST
Other Provider Identifier 4: P01037353
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 4: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 4: TN
Other Provider Identifier Issuer 4: RR MEDICARE
Is Sole Proprietor: N
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No
NPI Certification Date: 7/9/2020