Jackie A. Pandeya, APRN
Individual provider Active NPI Family Nurse Practitioner · Munfordville, KY
NPI 1447588488 · NPPES record last updated Sep 5, 2024
Key facts
- NPI
- 1447588488
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 1129819 (TX)
- Practice address
- 950 Main St.
Munfordville, KY 42765 - Phone
- (270) 524-1201
- Fax
- (270) 506-5972
- NPI assigned
- Dec 3, 2009
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX, UT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240410000704 | TX | Practitioner - Nurse Practitioner | 6800925710 | Reassigns benefits to 2 organizations |
| I20241107003097 | UT | Practitioner - Nurse Practitioner | 6800925710 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3006282 | KY | MD | Family Nurse Practitioner |
| NP-13005 | OH | MD | Family Nurse Practitioner |
| 1129819 | TX | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Integrated Clinix | Current |
Accepting new patients | |
| Home Clinix Utah LLC | Current |
Accepting new patients | |
| Home Clinix Texas LLC | Current |
Accepting new patients | |
| James Moss PLLC | Past | Accepting new patients | |
| C Fred Gott M.D. | Past | Accepting new patients |
Locations
13300 Old Blanco Rd
San Antonio, TX 78216
Phone (210) 314-3476
2128 Babcock Rd
#201B2
San Antonio, TX 78229
2128 Babcock Rd
Bldg 2
San Antonio, TX 78229
Phone (210) 201-5433
13300 Old Blanco Rd
Ste 295
San Antonio, TX 78216
Phone (915) 244-9257
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | NP-13005 | OH | |
| Family Nurse Practitioner | 363LF0000X | 3006282 | KY | |
| Family Nurse Practitioner | 363LF0000X | 1129819 | TX | Yes |
Addresses
Primary practice location
950 Main St.
Munfordville, KY 42765
Mailing address
201 Park St
Bowling Green, KY 42101-1759
Phone (270) 780-2497
Other names
- Ms. Jackie A. Wright
Other providers in Munfordville, KY
- Evelyn Salisbury Middleton
- James W Middleton Jr.
- Autumn Minch
- Kimberly Ann Owens
- Sandhya Pahuja
- Virag Pandeya
- Kelly C. Pate
- Anissa Pendleton
- Julie Percefull
- Brandy Gayle Pierce
All providers in Munfordville, KY · Family Nurse Practitioner in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 5, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.