Individual Healthcare Provider
Jackie A Church, APN
Provider's NPPES record last updated: October 14, 2025
Overview
- Entity Type
- Individual Healthcare Provider
- NPI
- 1629126321
- Primary Specialty
- Nurse Practitioner — Family
- Practice Location
- Lebanon, Virginia
- Sole Proprietor
- No
Federal Screening
NPISignal checked this NPI against federal exclusion sources. Results below are based on the NPI number itself — an identifier match, not a name match.
List of Excluded Individuals/Entities (LEIE)
HHS Office of Inspector General
No potential match was identified in NPISignal's indexed List of Excluded Individuals/Entities (LEIE) records as of 2026-09-10.
- Source data
- September 10, 2026
- Records indexed
- 84,001
- Screened
- Sep 21, 2026, 2:29 AM UTC
This reflects only the records NPISignal currently holds and the identity information supplied. It is not a verification of eligibility, licensure, or compliance. Verify decisions that matter against the authoritative source.
SAM.gov Exclusions
U.S. General Services Administration
SAM.gov Exclusions was not checked.
SAM.gov screening is not configured on this deployment. No SAM check has been performed.
- Screened
- Not checked
This is an NPI-based check only. NPISignal does not publish name-based exclusion matches on a provider profile. A shared or similar name is a lead that requires human review, not an identification, and this page is not the place to make one. Run a name-based screening below to see potential matches with the reasons for each.
This reflects only the records NPISignal currently holds and the identity information supplied. It is not a verification of eligibility, licensure, or compliance. Verify decisions that matter against the authoritative source.
Searches OIG LEIE and SAM.gov by name and reviews every potential match.
Specialties & Taxonomies
- Primary
Nurse Practitioner
Family
Physician Assistants & Advanced Practice Nursing Providers
Definition to come...
Taxonomy code 363LF0000X Registered Nurse
Nursing Service Providers
(1) A registered nurse is a person qualified by graduation from an accredited nursing school (depending upon schooling, a registered nurse may receive either a diploma from a hospital program, an associate degree in nursing (A.D.N.) or a Bachelor of Science degree in nursing (B.S.N.), who is licensed or certified by the state, and is practicing within the scope of that license or certification. R.N.'s assist patient in recovering and maintaining their physical or mental health. They assist physicians during treatments and examinations and administer medications. (2) A provider who is trained and educated in a formal nursing education program at an accredited school of nursing, passes a national certification examination, and is licensed by the state to practice nursing. The individual provides nursing services to patients or clients in areas such as health promotion, disease prevention, acute and chronic care and restoration and maintenance of health across the life span.
Taxonomy code 163W00000X
Provider-Reported License Information
- Nurse Practitioner (Tennessee)
- APN12537
- Nurse Practitioner (North Carolina)
- 5018685
- Registered Nurse (Tennessee)
- 143764
- Nurse Practitioner (Virginia)
- 0024187900
Practice Locations
Practice Location
344 Overlook Dr Ste 200
Lebanon, Virginia 24266-3436
Phone: (276) 883-5900
Additional Practice Location
130 W Ravine Rd
Kingsport, Tennessee 37660-3837
Phone: (423) 239-9737
Additional Practice Location
1 Medical Park Blvd Ste 102w
Bristol, Tennessee 37620-7430
Phone: (423) 844-1121
Additional Practice Location
1500 W Elk Ave
Elizabethton, Tennessee 37643-2654
Phone: (423) 543-2584
Fax: (423) 722-2060
Additional Practice Location
1420 Tusculum Blvd
Greeneville, Tennessee 37745-4279
Phone: (423) 787-5000
Additional Practice Location
108 Park Ave
Banner Elk, North Carolina 28604-6604
Phone: (828) 783-9183
Additional Practice Location
400 N State of Franklin Rd
Johnson City, Tennessee 37604-6035
Phone: (423) 431-6111
Additional Practice Location
2030 Temple Hill Rd
Erwin, Tennessee 37650-8721
Phone: (423) 735-4700
Additional Practice Location
111 W Stone Dr Ste 110
Kingsport, Tennessee 37660-6027
Phone: (423) 224-3701
Additional Practice Location
2000 Brookside Dr
Kingsport, Tennessee 37660-4627
Phone: (423) 857-7000
Additional Practice Location
4600 Fort Henry Dr
Kingsport, Tennessee 37663-2617
Phone: (423) 224-3950
Record Information
- Enumeration Date
- January 8, 2007
- Provider's NPPES Record Last Updated
- October 14, 2025
- Certification Date
- October 14, 2025
- NPISignal NPPES Dataset
- August 2026
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