NPIMap

Individual provider Active NPI

Jacqueline M Wolk, FNP

  • Family Nurse Practitioner
  • Bloomsdale, MO
National Provider Identifier
1144730615
Registry record updated Oct 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
2017036067 Issued in MO
Practice address
255 Boderman
Bloomsdale, MO 63627-9099
Phone
(573) 483-2929
Fax
(573) 483-9612
NPI assigned
Oct 10, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 2017036067 MO Primary

Addresses

Primary practice location

255 Boderman
Bloomsdale, MO 63627-9099

Mailing address

800 Ste Genevieve Dr
Ste Genevieve, MO 63670-1434
Phone (573) 883-7781

Other names 1

  • Jacqueline Marie Flavin Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171116003012 MO Practitioner - Nurse Practitioner 4688930092 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ste Genevieve County Memorial HospitalGroup PAC ID 3274432802, 74 clinicians

Practice addresses (Care Compare)

800 Genevieve Dr
Ste Genevieve, MO 63670-1434
Phone (573) 883-5717

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2017036067MOMDFamily Nurse Practitioner

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1507593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1507593600000",
    "number": "1144730615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 STE GENEVIEVE DR",
            "city": "STE GENEVIEVE",
            "state": "MO",
            "postal_code": "636701434",
            "telephone_number": "573-883-7781",
            "fax_number": "573-883-4411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 BODERMAN",
            "city": "BLOOMSDALE",
            "state": "MO",
            "postal_code": "636279099",
            "telephone_number": "573-483-2929",
            "fax_number": "573-483-9612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLK",
        "first_name": "JACQUELINE",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-10",
        "last_updated": "2017-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2017036067",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "FLAVIN",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Bloomsdale, MO

Sources for this page

Verify at the official NPI Registry.