Healthcare Provider Details

I. General information

NPI: 1215171608
Provider Name (Legal Business Name): JACQUELINE OWEN FNP-BC, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2009
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 DUNN RD # 405A
LUMBERTON NC
28358-7913
US

IV. Provider business mailing address

405 DUNN RD # 405A
LUMBERTON NC
28358-7913
US

V. Phone/Fax

Practice location:
  • Phone: 910-738-7865
  • Fax: 910-738-2860
Mailing address:
  • Phone: 910-738-7865
  • Fax: 910-738-2860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5018816
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5018816
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: