MEDICARE: MRS. JACLYN S QUALTER NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	205035	NC

General Provider Information

NPI Number	:	1174543730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JACLYN S QUALTER NP

Provider Business Mailing Address
First Line	:	406 US 1 HWY STE A
Second Line	:
City	:	YOUNGSVILLE
State	:	NC
Zip	:	27596-7847
Country	:	US
Telephone Number	:	919-679-1880
Fax Number	:	800-507-0902

Provider Business Practice Location Address
First Line	:	406 US 1 HWY STE A
Second Line	:
City	:	YOUNGSVILLE
State	:	NC
Zip	:	27596-7847
Country	:	US
Telephone Number	:	199-679-1880
Fax Number	:	800-507-0902

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	08/15/2024

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