Jacqueline Hicks

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

0000023945 Issued in TN

Practice address

284 Highway 641 N
Camden, TN 38320-1350

Phone

(731) 213-2446

Fax

(731) 213-2447

NPI assigned

Mar 26, 2018

Last updated

Nov 23, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Jacqueline Wilson Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jacqueline.wilson@fastpacemedical.com

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

• Fast Pace Medical Clinic PLLC

  • Family Medicine Physician
  • Spring Hill, TN
  • NPI 1134452865
  Medicare reassignment NPD
• Fast Pace Medical Clinic PLLC

  • Rural Health Clinic/Center
  • Chapel Hill, TN
  • NPI 1316602774
  NPD

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

{
    "created_epoch": "1522022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606089600000",
    "number": "1245735943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "284 HIGHWAY 641 N",
            "city": "CAMDEN",
            "state": "TN",
            "postal_code": "383201350",
            "telephone_number": "731-213-2446",
            "fax_number": "731-213-2447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "284 HIGHWAY 641 N",
            "city": "CAMDEN",
            "state": "TN",
            "postal_code": "383201350",
            "telephone_number": "731-213-2446",
            "fax_number": "731-213-2447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HICKS",
        "first_name": "JACQUELINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-26",
        "last_updated": "2020-11-23",
        "certification_date": "2020-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TN",
            "license": "0000023945",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "23945",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Jacqueline.wilson@fastpacemedical.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "personal information",
            "address_1": "284 Highway 641 N",
            "city": "Camden",
            "state": "TN",
            "country_code": "US",
            "postal_code": "383201350",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "WILSON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Suzanna B Greenwell, MSN-CRNA
• Michelle Morris Harrison, OD
• Roger Stephen Herndon, RPH
• Verneda L Herring, APN
• Avery Michelle Hicks
• Elliott B Hills, D.D.S.
• Tammie Sue Holcomb, DNP, AGACNP-BC
• Wendy Holladay
• Jason L Hollingsworth, MD
• Anne-Marie S Hollis, SLP

• Nurse Practitioner in Camden, TN
• Providers in Camden, TN by specialty
• Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.