Jackie Walgram, RN/HEALTH EDUCATOR

Primary specialty

Health EducatorTaxonomy code 174H00000X

License

4704132716 Issued in MI

Practice address

4881 Wil O Paw Dr
Coloma, MI 49038-8816

Phone

(269) 325-5659

NPI assigned

Aug 15, 2008

Reactivated

Jul 11, 2019

Last updated

Aug 14, 2019By 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 identifiers 1

Other names 1

• Ms. Jackie Howard Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1218758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565740800000",
    "number": "1740436286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4881 WIL O PAW DR",
            "city": "COLOMA",
            "state": "MI",
            "postal_code": "490388816",
            "telephone_number": "269-569-4509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4881 WIL O PAW DR",
            "city": "COLOMA",
            "state": "MI",
            "postal_code": "490388816",
            "telephone_number": "269-325-5659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALGRAM",
        "first_name": "JACKIE",
        "name_prefix": "Mrs.",
        "credential": "RN/HEALTH EDUCATOR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-08-15",
        "last_updated": "2019-08-14",
        "deactivation_date": "2019-07-01",
        "reactivation_date": "2019-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174H00000X",
            "taxonomy_group": "",
            "desc": "Health Educator",
            "state": "MI",
            "license": "4704132716",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "4704132716",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACKIE",
            "last_name": "HOWARD",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Health Educator in Coloma, MI
• Providers in Coloma, MI by specialty
• Health Educator in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2019; 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.