Jacqueline Louise Wellborn

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

2021118463 Issued in TX

Practice address

104 S Walnut St
Hico, TX 76457

Phone

(254) 796-4224

Fax

(866) 264-2163

NPI assigned

Nov 2, 2021

Last updated

Aug 14, 2023By 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 2

Addresses

Other names 1

• Jacqueline Weathers Former name

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Hamilton County Hospital DistrictGroup PAC ID 2062326234, 24 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Hamilton General Hospital Hospital, Hamilton, TX, CCN 451392

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Hamilton County Hospital District

  dba Hamilton General Hospital

  • Critical Access Hospital
  • Hamilton, TX
  • NPI 1326037607
  Medicare reassignment Care Compare group NPD
• Hamilton County Hospital District

  dba Avir at Southcross

  • Skilled Nursing Facility
  • San Antonio, TX
  • NPI 1952637316
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Hamilton County Hospital District

  dba Hamilton General Hospital

  • Critical Access Hospital
  • Hamilton, TX
  • NPI 1326037607
  Care Compare affiliation

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

{
    "created_epoch": "1635811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691971200000",
    "number": "1871258152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 N BROWN ST",
            "city": "HAMILTON",
            "state": "TX",
            "postal_code": "765311518",
            "telephone_number": "254-386-1895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 S WALNUT ST",
            "city": "HICO",
            "state": "TX",
            "postal_code": "76457",
            "telephone_number": "254-796-4224",
            "fax_number": "866-264-2163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WELLBORN",
        "first_name": "JACQUELINE",
        "middle_name": "LOUISE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-11-02",
        "last_updated": "2023-08-14",
        "certification_date": "2023-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "2021118463",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TX",
            "license": "883588",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "WEATHERS",
            "credential": "FNP-BC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• The Dwelling Place Senior Living, LLC (Hill Country Estates of Hico)
• Ticknor Enterprises Hico Alf, LLC (Hill Country Estates of Hico)
• Touchstone Ranch Recovery Center, LLC
• Trinity Massage Therapy, LLC
• TTCM 1 LP (Hico Care Center)
• Heather Wyatt, NP

• Family Nurse Practitioner in Hico, TX
• Providers in Hico, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.