Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

ANGEL JACKSON
NPI 1407560402
Nurse Practitioner - Primary Care in Charleston, WV

Q: What is Angel Jackson's NPI number?

The NPI number for Angel Jackson is 1407560402. It was assigned to this individual provider in the NPPES registry on January 13, 2023.

Q: What is Angel Jackson's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Primary Care, with taxonomy code 363LP2300X.

Q: When was this NPI record last updated?

The NPPES record for Angel Jackson was last updated on July 29, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 30 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since January 13, 2023

400 S RUFFNER RD STE 11, CHARLESTON, WV 25314(304) 720-9595 Get Directions Write a Review

NPPES record last updated: July 29, 2026. Verified against the NPPES registry weekly; last sync: August 23, 2026.

Record update history: Jul 29, 2026, Mar 4, 2026, Jan 13, 2023 (3 updates tracked since 2023).

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About Angel Jackson NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ANGEL JACKSON (NPI 1407560402) is an individual primary care provider in Charleston, West Virginia, licensed in West Virginia (123472) and active in the NPI registry since January 2023.

NPPES Registry Identity

NPI1407560402

Entity TypeIndividualFemale

Primary Taxonomy363LP2300X

Provider Legal NameANGEL JACKSON

Location Address400 S RUFFNER RD STE 11Charleston, WV 25314-1542

Mailing Address2866 Mudfork RoadVerdunville, WV 25649 · (304) 784-0989

Phone(304) 720-9595

Sole ProprietorNo

Enumeration DateJanuary 13, 2023

Last NPPES UpdateJuly 29, 20263 updates tracked since enumeration

NPPES CertifiedJuly 29, 2026

✔ NPI 1407560402 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · Primary CarePhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LP2300X

License✔ Licensed in WV · 123472

Also ListedRegistered NurseTaxonomy 163W00000X · License 91990 (WV)

400 S RUFFNER RD STE 11, Charleston, WV 25314

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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Angel Jackson's NPI number?

The NPI number for Angel Jackson is 1407560402. It was assigned to this individual provider in the NPPES registry on January 13, 2023.

Where is Angel Jackson located?

Angel Jackson practices at 400 S Ruffner Rd Ste 11, Charleston, WV 25314. The listed phone number is (304) 720-9595.

What is Angel Jackson's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Primary Care, with taxonomy code 363LP2300X.

When was this NPI record last updated?

The NPPES record for Angel Jackson was last updated on July 29, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 30 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.