Individual
JACQUELYN E VAN WATERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
2670 NEW HOLT RD STE C, PADUCAH, KY 42001-7506
(270) 575-1010
(270) 575-1007
Mailing address
607 MINTER RD, SYMSONIA, KY 42082-9402
(270) 703-9095
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
3011205
KY
Other
Enumeration date
01/15/2017
Last updated
07/21/2022
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