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General NPI Number Information
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NPI Number | 1972697696
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Entity Type | Individual
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Provider Name | JACQUELYN MARIE WOOLDRIDGE CNS
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Gender | Female
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 04/24/2019
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Provider Practice Location Address
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Address Line | 3901 E 32ND ST
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City | JOPLIN
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State | MO
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Zip | 64804-3312
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Country | US
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Telephone | 417-347-7540
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Fax | 417-347-7549
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Provider Business Mailing Address
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Address Line | PO BOX 2526
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City | JOPLIN
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State | MO
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Zip | 64803-2526
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Country | US
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Telephone | 417-347-7540
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Fax | 417-347-7549
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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 | 364SP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | 2000174217
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License Number State | MO
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