JACQUELINE CAROLYN EDWARDS (NPI# 1740688910) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740688910 |
| Entity Type | Individual |
| Full Name | JACQUELINE CAROLYN EDWARDS |
| Credential | N.P., RN |
| Practice Address |
8081 Tara Blvd 265 Jonesboro GA 30236 |
| Practice Telephone | 6788155446 |
| Practice Fax Number | 1888291928 |
| Mailing Telephone | 6788155446 |
| Mailing Fax Number | 1888291928 |
| Enumeration Date | 2014-12-19 |
| Last Update Date | 2016-12-13 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | RN139678 | GA | Nursing Service Providers |
| N | 163W00000X | Registered Nurse | 28131113A | IN | Nursing Service Providers |
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
71005657A | IN | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
RN139678 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487918595 | Jacqueline Edwards | Psychologist | 370 Casa Norte Dr Unit 2064, North Las Vegas, NV 89031-3344 | 2012-07-03 |
| 1295285773 | Jacqueline Edwards | Physician Assistant | 701 Ostrum St, Suite 201, Fountain Hill, PA 18015-1155 | 2016-10-10 |
| 1336306760 | Jacqueline Marie Edwards | Licensed Practical Nurse | 300 W Mcnichols Rd, Detroit, MI 48203-2703 | 2008-05-22 |
| 1033239793 | Jacqueline Edwards | Rehabilitation Practitioner | 456 Elm Ave, Long Beach, CA 90802-2426 | 2007-03-29 |
| Street Address |
8081 TARA BLVD 265 |
| City | JONESBORO |
| State | GA |
| Zip Code | 30236 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972123362 | Life Source Counseling & Consulting, LLC | Clinic/Center | 118 North Avenue, Suite A, Jonesboro, GA 30236 | 2020-04-25 |
| 1639609555 | New Beginnings Behavioral Counseling,llc | Social Worker | 9456 S Main St Ste E2, Jonesboro, GA 30236 | 2017-06-13 |
| 1437696762 | Clarissa Alexandra Poole | Counselor | 2106 Fair Ridge Ct, Jonesboro, GA 30236 | 2017-01-25 |
| 1588012892 | Sundance Healthcare Service Inc | In Home Supportive Care | 7861 Collinswood Court, Jonesboro, GA 30236 | 2016-05-26 |
| 1942669205 | Adrianne Smiley Gurley | Occupational Therapist | 1299 Battlecreek Rd Ste 210, Jonesboro, GA 30236 | 2016-02-15 |
| 1336505809 | Integrated Health Center | Dentist | 8600 Tara Blvd, Suite D, Jonesboro, GA 30236 | 2016-01-13 |
| 1467827402 | Surrell Porter | Nurse Practitioner | 1287 Georgia Highway 138 Spur, Suite 8, Jonesboro, GA 30236 | 2015-12-02 |
| 1770991861 | Lower Extremity Diagnostics, LLC | Podiatrist | 6911 Tara Boulevard, Jonesboro, GA 30236 | 2014-08-01 |
| 1760899710 | Fresenius Medical Care Jonesboro, LLC | Clinic/Center | 8060 Summitt Business Parkway, Jonesboro, GA 30236 | 2014-07-22 |
| 1184045163 | Diane Johnson | Community/Behavioral Health | 1141 Gable Terrace, Jonesboro, GA 30236 | 2013-12-18 |
| Find all providers in zip 30236 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457958233 | Kaitlyn Soffray Simmons | Nurse Practitioner | 500 Kitchen St, Jonesboro, AR 72401-3135 | 2020-10-05 |
| 1407463938 | Aleshia Williams | Nurse Practitioner | 5401 Clear Creek Ln, Jonesboro, AR 72404-7006 | 2020-09-29 |
| 1790397495 | Kbsolutions and Behavioral Support Services, LLC | Nurse Practitioner | 7265 Mount Zion Blvd Ste 1, Jonesboro, GA 30236-2519 | 2020-08-24 |
| 1568080646 | Maryam A Muhammad | Nurse Practitioner | 2388 Reeves Creek Rd, Jonesboro, GA 30236-7229 | 2020-07-06 |
| 1346864121 | Joy Brew | Nurse Practitioner | 8399 Members Dr, Jonesboro, GA 30236-4271 | 2020-06-08 |
| 1053932806 | Sabrina Nannettee Bowen | Nurse Practitioner | 5800 C W Post Rd, Jonesboro, AR 72401-9602 | 2020-05-04 |
| 1265993182 | Sara Ruth Johnson | Nurse Practitioner | 701 Windover Rd Ste 400, Jonesboro, AR 72401-6065 | 2019-03-26 |
| 1366927956 | Yolanda Louise Davis | Nurse Practitioner | 1706 Heather Ridge Dr, Jonesboro, AR 72401-3748 | 2018-09-28 |
| 1457867475 | Eucharia Udoka Obi | Nurse Practitioner | 9051 Jenni Cir, Jonesboro, GA 30238-6800 | 2017-12-28 |
| 1346752151 | Chanel Dominque Bullock | Nurse Practitioner | 1150 E Matthews Ave Ste 203, Jonesboro, AR 72401 | 2017-11-02 |
| Find all providers in JONESBORO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.