Provider Demographics
NPI:1437853744
Name:JACQUES, KATELYN KEITH (DNP A-GNP)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:KEITH
Last Name:JACQUES
Suffix:
Gender:F
Credentials:DNP A-GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3560 MOUNT HERMON ROCK CRK RD
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27253-9712
Mailing Address - Country:US
Mailing Address - Phone:704-776-2777
Mailing Address - Fax:
Practice Address - Street 1:407 CRUTCHFIELD ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2726
Practice Address - Country:US
Practice Address - Phone:919-660-2324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCKEIT-Y8EZ5363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health