Individual provider Active NPI

Jacqueline C Qualles, CRNA

  • Certified Registered Nurse Anesthetist
  • Durham, NC
National Provider Identifier
1407990468
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
343495 Issued in PA
Practice address
1104 Red Oak Ave
Durham, NC 27707-4924
Phone
(919) 806-9202
NPI assigned
Feb 16, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 343495L PA
Certified Registered Nurse Anesthetist 367500000X 343495 PA Primary

Addresses

Primary practice location

1104 Red Oak Ave
Durham, NC 27707-4924

Mailing address

1104 Red Oak Ave
Durham, NC 27707-4924
Phone (919) 806-9202

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)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
343495LPAMDRegistered Nurse
343495PAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Lenoir Memorial Hospital, Incorporated Past Accepting new patients
Lenoir Memorial Hospital, Incorporated Nurse Anesthetist, Certified Registered Past Accepting new patients
Orange Anesthesia Services P.C.. Past Accepting new patients
Pittsburgh Anesthesia Associates, LTD. Past Accepting new patients
Chambersburg Anesthesia Associates Nurse Anesthetist, Certified Registered Past Accepting new patients

Organizations & group practices 5

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": "1171584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1407990468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1104 RED OAK AVE",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277074924",
            "telephone_number": "919-806-9202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1104 RED OAK AVE",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277074924",
            "telephone_number": "919-806-9202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUALLES",
        "first_name": "JACQUELINE",
        "middle_name": "C",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-16",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "PA",
            "license": "343495L",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "PA",
            "license": "343495",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Durham, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.