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Individual

JACQUELYN DONNELLY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
ACNP

Contact information

Practice address
2714 UNION AVENUE EXT, SUITE 150, MEMPHIS, TN 38112-4431
(901) 725-0872
(901) 278-6934
Mailing address
2714 UNION AVENUE EXT, SUITE 150, MEMPHIS, TN 38112-4431
(901) 725-0872
(901) 278-6934

Taxonomy

Speciality
Code
Description
License number
State
364S00000X
Clinical Nurse Specialist
Primary
10658
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
10350I6318
MEDICARE PTAN
TN
05
1512704
TN
01
4321835
BCBST
TN
Enumeration date
03/23/2007
Last updated
09/14/2012
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