Jacqueline Danielle Allen, PMHNP-BC
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Fort Stewart, GA
NPI 1376202309 · NPPES record last updated Nov 12, 2024
Key facts
- NPI
- 1376202309
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 2021047406 (MO)
- Practice address
- 1061 Harmon Ave
Fort Stewart, GA 31314-5641 - Phone
- (912) 435-6965
- NPI assigned
- Dec 17, 2021
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2021047406 | MO | MD | Psychiatric/Mental Health Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 2021047406 | MO | Yes |
Addresses
Primary practice location
1061 Harmon Ave
Fort Stewart, GA 31314-5641
Mailing address
1061 Harmon Ave
Fort Stewart, GA 31314-5641
Other practice location 1
4430 Missouri Ave
Fort Leonard Wood, MO 65473-9098
Phone (573) 596-0417
Other providers in Fort Stewart, GA
- Ralinson Alcius
- Marie Alexandra Alexander
- Adrienne Brentzel Allen
- Elizabeth Sue Allen
- Ian M Allen
- Kathleen Shea Allen
- Natalie Y Allen
- Stephen Allen
- Natalie Cowell Almonte
- Samuel Altman
All providers in Fort Stewart, GA · Psychiatric/Mental Health Nurse Practitioner in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 12, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.