Provider Demographics
NPI:1194360446
Name:CROPPER, JACQUELINE K (APRN, IBCLC, PMH-C)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:K
Last Name:CROPPER
Suffix:
Gender:F
Credentials:APRN, IBCLC, PMH-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E MAIN AVE STE 310B
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-6900
Mailing Address - Country:US
Mailing Address - Phone:270-697-9174
Mailing Address - Fax:
Practice Address - Street 1:400 E MAIN AVE STE 310B
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-6900
Practice Address - Country:US
Practice Address - Phone:270-697-9174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-11
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYL-47082163WL0100X
TN28172363LF0000X
KY3014655363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant