Healthcare Provider Details

I. General information

NPI: 1487058079
Provider Name (Legal Business Name): JACQUELINE JILL BRAUN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACQUELINE JILL TUGGLE

II. Dates (important events)

Enumeration Date: 10/10/2014
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BRECKENRIDGE ST STE 401
OWENSBORO KY
42303-0878
US

IV. Provider business mailing address

PO BOX 23229
OWENSBORO KY
42304-3229
US

V. Phone/Fax

Practice location:
  • Phone: 270-688-4401
  • Fax: 270-688-4409
Mailing address:
  • Phone: 270-688-1330
  • Fax: 270-688-1338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3008949
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: