Healthcare Provider Details

I. General information

NPI: 1235656695
Provider Name (Legal Business Name): JAIME NICOLE OWENS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2017
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 OLD YORK RD
JENKINTOWN PA
19046-1601
US

IV. Provider business mailing address

211 E CLAREMONT RD
PHILADELPHIA PA
19120-1013
US

V. Phone/Fax

Practice location:
  • Phone: 215-886-2923
  • Fax:
Mailing address:
  • Phone: 215-237-5963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSPO17445
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberSPO17445
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: