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General NPI Number Information
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NPI Number | 1619489010
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Entity Type | Individual
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Provider Name | JACQUELINE TOWNSEND NP-C
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Gender | Female
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Dates
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Enumeration Date | 10/26/2017
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Last Update Date | 08/30/2019
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Provider Practice Location Address
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Address Line | 1202 N MUSKOGEE PL
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City | CLAREMORE
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State | OK
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Zip | 74017-3058
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Country | US
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Telephone | 918-342-2558
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Fax |
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Provider Business Mailing Address
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Address Line | 14090 S 4180 RD
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City | CLAREMORE
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State | OK
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Zip | 74017-3496
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Country | US
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Telephone | 918-693-4576
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 85792
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 85792
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License Number State | OK
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