Jacqueline Couch, CNA

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

License

257401 Issued in IA

Practice address

2594 NW 152ND St
Clive, IA 50325-4533

Phone

(515) 987-8155

NPI assigned

Feb 13, 2015

Last updated

Feb 13, 2015By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Jacqueline Denise Rose Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1423785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1423785600000",
    "number": "1528459393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2594 NW 152ND ST",
            "city": "CLIVE",
            "state": "IA",
            "postal_code": "503254533",
            "telephone_number": "515-987-8155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2594 NW 152ND ST",
            "city": "CLIVE",
            "state": "IA",
            "postal_code": "503254533",
            "telephone_number": "515-987-8155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COUCH",
        "first_name": "JACQUELINE",
        "credential": "CNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-02-13",
        "last_updated": "2015-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "IA",
            "license": "257401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "ROSE",
            "middle_name": "DENISE",
            "prefix": "MRS.",
            "credential": "CNA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Brittany Julia Cook, RBT
• Brian Christopher Cooper, M.D.
• Cornerstone Dental of Clive LLC (Cornerstone Dental)
• Drew Joseph Corpstein, D.C.
• Cosm LLP
• Stephanie Lynn Courson Pothoven, DO
• Marcy Michelle Covert, FNP-C
• Taylor Rae Crane, OTD, OTR/L
• Melissa June Cribari, LMHC, CADC
• Alexandria Frances Critelli

• Community Health Worker in Clive, IA
• Providers in Clive, IA by specialty
• Community Health Worker in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2015; 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.