Provider Demographics
NPI:1083376339
Name:BROWNING, JACQUELINE BLUE (MSN-APRRN,APRN-PMHNP)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:BLUE
Last Name:BROWNING
Suffix:
Gender:F
Credentials:MSN-APRRN,APRN-PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2536 TAYLORSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-2231
Mailing Address - Country:US
Mailing Address - Phone:213-308-1987
Mailing Address - Fax:
Practice Address - Street 1:8442 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40258-1140
Practice Address - Country:US
Practice Address - Phone:270-255-4341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3016826363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health