1902370497 NPI number — MRS. JACQUELINE SUSANN BROWN STICKEL NURSE PRACTITIONER

Table of content: DR. NIDHI GEHLOT D.M.D (NPI 1174751887)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902370497 NPI number — MRS. JACQUELINE SUSANN BROWN STICKEL NURSE PRACTITIONER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STICKEL
Provider First Name:
JACQUELINE
Provider Middle Name:
SUSANN BROWN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACTITIONER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902370497
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
254 FITZGERALD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GERRARDSTOWN
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25420-1404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-533-1965
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 E 5TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RANSON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25438-1613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-728-1812
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/17/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  0024176995 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: APRN97879NP , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0024176995 . This is a "VA APRN LICENSE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: F11180017 . This is a "AMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION BOARD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0001131963 . This is a "VA RN LICENSE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: APRN97879NP . This is a "WV APRN LICENSE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 97879 . This is a "WV RN LICENS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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