MEDICARE: JACQUELYN DONNELLY ACNP

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	364S00000X	Clinical Nurse Specialist	10658	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10350I6318	OTHER	TN	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4321835	OTHER	TN	BCBST

General Provider Information

NPI Number	:	1528185568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELYN DONNELLY ACNP

Provider Business Mailing Address
First Line	:	2714 UNION AVENUE EXT
Second Line	:	SUITE 150
City	:	MEMPHIS
State	:	TN
Zip	:	38112-4431
Country	:	US
Telephone Number	:	901-725-0872
Fax Number	:	901-278-6934

Provider Business Practice Location Address
First Line	:	2714 UNION AVENUE EXT
Second Line	:	SUITE 150
City	:	MEMPHIS
State	:	TN
Zip	:	38112-4431
Country	:	US
Telephone Number	:	901-725-0872
Fax Number	:	901-278-6934

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

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	09/14/2012

Similar Medicare Providers

1821808387 — DR. KELLY W WHITE M.D.
Practice Location Address:

2714 UNION AVENUE EXT STE 150
MEMPHIS, TN
38112-4431

Practice Phone: 901-725-0872
Practice Fax:

1205057957 — SONAL SUJIT MEHR MD
Practice Location Address:

2714 UNION AVENUE EXT STE 150
MEMPHIS, TN
38112-4431

Practice Phone: 901-725-0872
Practice Fax: 901-278-6934

1063882280 — AUDRA BLYE LEWIS NP
Practice Location Address:

2714 UNION EXTD , SUITE 150
MEMPHIS, TN
38112-4431

Practice Phone: 901-725-0872
Practice Fax: 901-278-6934

1346735685 — DR. JAMES JOSEPH RYAN MD
Practice Location Address:

2714 UNION AVENUE EXT STE 150
MEMPHIS, TN
38112-4431

Practice Phone: 901-725-0872
Practice Fax: 901-278-6934

1245837533 — MS. SANDRA DEE GARRISON APRN
Practice Location Address:

335 LILLIAN DR
MEMPHIS, TN
38109-4431

Practice Phone: 901-653-4136
Practice Fax:

1598348211 — TRINITY HOLISTIC PRIMARY CARE
Practice Location Address:

335 LILLIAN DR
MEMPHIS, TN
38109-4431

Practice Phone: 901-653-4136
Practice Fax: 901-509-3991

Directions to “ JACQUELYN DONNELLY ACNP” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.