Healthcare Provider Details

I. General information

NPI: 1205359940
Provider Name (Legal Business Name): JACQUELINE KAY ALLEN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. JACQUELINE KAY EGGER

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 REILLY ST
FORT BRAGG NC
28310-7324
US

IV. Provider business mailing address

2817 REILY ROAD WOMACK ARMY MEDICAL CENTER
FORT BRAGG NC
28310
US

V. Phone/Fax

Practice location:
  • Phone: 910-907-8697
  • Fax: 910-907-8617
Mailing address:
  • Phone: 910-907-8697
  • Fax: 910-907-8617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberAP131469
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: