Active NPI
Jacqueline Deen
- Health Maintenance Organization
- Roswell, NM
National Provider Identifier
1134540131
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Health Maintenance Organization
- Practice address
- 102 S Missouri Ave
Roswell, NM 88203-4448 - Phone
- (575) 309-5570
- NPI assigned
- Dec 18, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Maintenance Organization | 302R00000X | Primary |
Addresses
Primary practice location
102 S Missouri Ave
Roswell, NM 88203-4448
Mailing address
102 S Missouri Ave
Roswell, NM 88203-4448
Phone (575) 309-5570
Other names 1
- Jackie Deen
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1387324800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1387324800000",
"number": "1134540131",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "102 S MISSOURI AVE",
"city": "ROSWELL",
"state": "NM",
"postal_code": "882034448",
"telephone_number": "575-309-5570"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "102 S MISSOURI AVE",
"city": "ROSWELL",
"state": "NM",
"postal_code": "882034448",
"telephone_number": "575-309-5570"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEEN",
"first_name": "JACQUELINE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-12-18",
"last_updated": "2013-12-18",
"status": "A"
},
"taxonomies": [
{
"code": "302R00000X",
"taxonomy_group": "",
"desc": "Health Maintenance Organization",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JACKIE",
"last_name": "DEEN",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Roswell, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.