Jacquelyn Elaine Roberts, ARNP

Primary specialty

Obstetrics & Gynecology Nurse PractitionerTaxonomy code 363LX0001X

License

RN128424 Issued in GA

Practice address

115 31St Ave SE
Moultrie, GA 31768-6771

Phone

(229) 890-1665

Fax

(229) 985-5050

NPI assigned

Sep 9, 2005

Last updated

Jul 13, 2026By 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 identifiers 1

Other names 1

• Jacquelyn Elaine Shaddix Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1126224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1801880497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 31ST AVE SE",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317686771",
            "telephone_number": "229-890-1665",
            "fax_number": "229-985-5050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 31ST AVE SE",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317686771",
            "telephone_number": "229-890-1665",
            "fax_number": "229-985-5050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "JACQUELYN",
        "middle_name": "ELAINE",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-09",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LX0001X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": "GA",
            "license": "RN128424",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00829617C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELYN",
            "last_name": "SHADDIX",
            "middle_name": "ELAINE",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Renal Treatment Centers Mid Atlantic Inc (Moultrie Dialysis Center)
• Jordan Boyd Rentz, FNP
• Respi-Care, Inc.
• Glenn Howard Ritchie, LCSW
• Don Wayne Roberts, MD
• Jeffrey W Roberts, CRNA
• Miranda Robinson Taylor, HAIR LOSS SPECIALIST
• Jermaine Marquis Robinson, DO
• Ronald E Trescot MD PC
• Caleb Joshua Rowan, MD

• Obstetrics & Gynecology Nurse Practitioner in Moultrie, GA
• Providers in Moultrie, GA by specialty
• Obstetrics & Gynecology Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.