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General NPI Number Information
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NPI Number | 1740024678
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Entity Type | Individual
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Provider Name | KATHLEEN ST JACQUES FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 06/25/2024
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 63 THOMAS JOHNSON DR STE E
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City | FREDERICK
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State | MD
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Zip | 21702-4399
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Country | US
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Telephone | 301-694-7600
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Fax |
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Provider Business Mailing Address
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Address Line | 63 THOMAS JOHNSON DR STE E
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City | FREDERICK
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State | MD
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Zip | 21702-4399
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Country | US
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Telephone | 301-694-3111
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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 | 0024190510
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AC007237
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License Number State | MD
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