Active NPI
Jacqueline Kracker, PH.D.
- Clinical Psychologist
- Mountain Home, TN
National Provider Identifier
1700045457
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2926
- Practice address
- James H Quillen VA Medical Center
Psychology Service
Mountain Home, TN 37684 - Phone
- (423) 979-4341
- NPI assigned
- Jun 7, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2926 | TN | Primary |
Addresses
Primary practice location
James H Quillen VA Medical Center
Psychology Service
Mountain Home, TN 37684
Mailing address
James H Quillen VA Medical Center
P.O. Box 4000 Mail Stop 122HB
Mountain Home, TN 37684
Phone (423) 979-4341
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)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2926 | TN | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1212796800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1268524800000",
"number": "1700045457",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "JAMES H QUILLEN VA MEDICAL CENTER",
"address_2": "P.O. BOX 4000 MAIL STOP 122HB",
"city": "MOUNTAIN HOME",
"state": "TN",
"postal_code": "37684",
"telephone_number": "423-979-4341"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "JAMES H QUILLEN VA MEDICAL CENTER",
"address_2": "PSYCHOLOGY SERVICE",
"city": "MOUNTAIN HOME",
"state": "TN",
"postal_code": "37684",
"telephone_number": "423-979-4341"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRACKER",
"first_name": "JACQUELINE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-06-07",
"last_updated": "2010-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "TN",
"license": "2926",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mountain Home, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.