Jackie Gwenn Tawoda, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

3018842 Issued in KY

Practice address

850 Riverview Ave
Pineville, KY 40977-1452

Phone

(606) 654-4526

NPI assigned

Jan 9, 2023

Last updated

Oct 21, 2024By 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 1

Addresses

Other names 1

• Miss Jackie Ellis Former name

Medicare fee-for-service enrollment

Enrolled in KY

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

Specialty

Nurse Practitioner

Education

Lincoln Memorial University Medical Department, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pineville Community Health Center IncGroup PAC ID 5698009157, 39 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Pineville Community Health Center, Inc Hospital, Pineville, KY, CCN 180154

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Pineville Community Health Center Inc

  • Certified Registered Nurse Anesthetist
  • Pineville, KY
  • NPI 1275192924
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Pineville Community Health Center Inc

  • General Acute Care Hospital
  • Pineville, KY
  • NPI 1285292219
  Care Compare affiliation

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

{
    "created_epoch": "1673222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729468800000",
    "number": "1487368049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "268 SADIE LN",
            "city": "EWING",
            "state": "VA",
            "postal_code": "242488797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 RIVERVIEW AVE",
            "city": "PINEVILLE",
            "state": "KY",
            "postal_code": "409771452",
            "telephone_number": "606-654-4526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAWODA",
        "first_name": "JACKIE",
        "middle_name": "GWENN",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-01-09",
        "last_updated": "2024-10-21",
        "certification_date": "2024-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3018842",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACKIE",
            "last_name": "ELLIS",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Steven K. Morgan, M.D PSC (Ima,PSC)
• Cody Stewart, PHARMD
• Kelly Renee Stewart, APRN
• Talmadge Hays PSC
• Talmadge V Hays PSC
• Taylor Drug Store, LLC
• William Jason Taylor, R PH
• Taylor's Discount Pharmacy
• Tennessee Cancer Specialists PLLC
• The Therapy Playground

• Family Nurse Practitioner in Pineville, KY
• Providers in Pineville, KY by specialty
• Family Nurse Practitioner in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.