Provider Demographics
NPI:1366042715
Name:OWENS, JACQUELINE ANN (PMHNP-BC, RN, ACM)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ANN
Last Name:OWENS
Suffix:
Gender:F
Credentials:PMHNP-BC, RN, ACM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 HAMMOND AVE
Mailing Address - Street 2:
Mailing Address - City:COHASSET
Mailing Address - State:MA
Mailing Address - Zip Code:02025-1928
Mailing Address - Country:US
Mailing Address - Phone:339-499-8753
Mailing Address - Fax:
Practice Address - Street 1:32 HAMMOND AVE
Practice Address - Street 2:
Practice Address - City:COHASSET
Practice Address - State:MA
Practice Address - Zip Code:02025-1928
Practice Address - Country:US
Practice Address - Phone:339-499-8753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA214339363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health