Jackie Marie Jacques, PTA 16675171

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

16675171 Issued in WA

Practice address

29804 Highway 101
Suite #5
Quilcene, WA 98376

Phone

(360) 765-0888

NPI assigned

Feb 22, 2022

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

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": "1645488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645488000000",
    "number": "1588319214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 578",
            "city": "SEQUIM",
            "state": "WA",
            "postal_code": "983824309",
            "telephone_number": "360-649-5596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29804 HIGHWAY 101",
            "address_2": "SUITE #5",
            "city": "QUILCENE",
            "state": "WA",
            "postal_code": "98376",
            "telephone_number": "360-765-0888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACQUES",
        "first_name": "JACKIE",
        "middle_name": "MARIE",
        "credential": "PTA 16675171",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-02-22",
        "last_updated": "2022-02-22",
        "certification_date": "2022-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WA",
            "license": "16675171",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sherrell C Fields, RN
• Amanda Groody
• Kirsten Rebecca Hall, LMT
• Shea S. Harrington, LMHCA
• Elizabeth Patricia Hendricks, M.A., L.M.H.C.
• Jefferson County Fire Protection District 2
• Jefferson County Public Hospital District No 2
• Ann Mrlowe Kittredge, LMP
• Keith David Meyer, D.C.
• Thomas D Meyer, LMP, CCSP

• Physical Therapy Assistant in Quilcene, WA
• Providers in Quilcene, WA by specialty
• Physical Therapy Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2022; 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.