Provider Demographics
NPI:1619489010
Name:TOWNSEND, JACQUELINE (NP-C)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:TOWNSEND
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:HARMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:14090 S 4180 RD
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-3496
Mailing Address - Country:US
Mailing Address - Phone:918-693-4576
Mailing Address - Fax:
Practice Address - Street 1:1202 N MUSKOGEE PL
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-3058
Practice Address - Country:US
Practice Address - Phone:918-342-2558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-26
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK85792363LF0000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily