JACQUELINE FELICIA CANNON APRN, AGPCNP
NPI 1801696380
Nurse Practitioner - Gerontology in Raleigh, NC

Q: What is Jacqueline Cannon's NPI number?

The NPI number for Jacqueline Cannon is 1801696380. It was assigned to this individual provider in the NPPES registry on March 14, 2025.

Q: What is Jacqueline Cannon's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Gerontology, with taxonomy code 363LG0600X.

Q: When was this NPI record last updated?

The NPPES record for Jacqueline Cannon was last updated on March 24, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 months 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 March 14, 2025PECOS Enrolled

160 MINE LAKE CT STE 200, RALEIGH, NC 27615(855) 984-5121 Get Directions Write a Review

NPPES record last updated: March 24, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Mar 24, 2025, Mar 14, 2025 (2 updates tracked since 2025).

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About Jacqueline Felicia Cannon Aprn, Agpcnp NPPES

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

JACQUELINE FELICIA CANNON APRN, AGPCNP (NPI 1801696380) is an individual gerontology provider in Raleigh, North Carolina, licensed in North Carolina (5021868) and active in the NPI registry since March 2025. She is enrolled in Medicare PECOS and is a graduate of Other (2024).

NPPES Registry Identity

NPI1801696380

Entity TypeIndividualFemale

Primary Taxonomy363LG0600X

Provider Legal NameJACQUELINE FELICIA CANNONCredential: APRN, AGPCNP

Location Address160 MINE LAKE CT STE 200Raleigh, NC 27615-6417

Mailing Address160 Mine Lake Ct Ste 200Raleigh, NC 27615-6417 · (919) 630-3936

Phone(855) 984-5121

Sole ProprietorYes

Medical School CMSOtherGraduated 2024

Enumeration DateMarch 14, 2025

Last NPPES UpdateMarch 24, 20252 updates tracked since enumeration

NPPES CertifiedMarch 24, 2025

✔ NPI 1801696380 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

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

Taxonomy Code363LG0600X

License✔ Licensed in NC · 5021868

160 MINE LAKE CT STE 200, Raleigh, NC 27615

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jacqueline Felicia Cannon Aprn, Agpcnp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID9133600828

PECOS Enrollment IDI20260220001367

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 27615 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$83.90 typical visit price

range $54.12 – $165.09

Typical copayment $20.97 (range $13.53 – $41.27)

Most-billed visit code 99203

Established Patient

$95.94 typical visit price

range $17.21 – $134.61

Typical copayment $23.98 (range $4.30 – $33.65)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 14

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

BRANDON GOLD P.A.

Physician Assistant (Surgical)