# JACQUELYN R MARTIN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1942421672
- **Gender:** F
- **Credential:** CNM

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LW0102X | Women's Health Nurse Practitioner | 3015292 | KY | — |
| 367A00000X | Advanced Practice Midwife | 09000415A | IN | Yes |
| 367A00000X | Advanced Practice Midwife | COA 07946 NM | OH | — |

## Other

- **Enumeration date:** 05/01/2007
- **Last updated:** 02/09/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0099346 | — | OH |
| 01 | — | 07946 | OHIO LICENSE | OH |
| 01 | — | 090540823 | MEDICARE | IN |
| 05 | — | 300002078 | — | IN |