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General NPI Number Information
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NPI Number | 1528185568
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Entity Type | Individual
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Provider Name | JACQUELYN DONNELLY ACNP
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Gender | Female
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 09/14/2012
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Provider Practice Location Address
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Address Line | 2714 UNION AVENUE EXT SUITE 150
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City | MEMPHIS
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State | TN
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Zip | 38112-4431
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Country | US
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Telephone | 901-725-0872
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Fax | 901-278-6934
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Provider Business Mailing Address
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Address Line | 2714 UNION AVENUE EXT SUITE 150
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City | MEMPHIS
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State | TN
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Zip | 38112-4431
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Country | US
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Telephone | 901-725-0872
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Fax | 901-278-6934
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number | 10658
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License Number State | TN
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