Provider Demographics
NPI:1578916698
Name:CAFFREY, JACQUELINE MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:MARIE
Last Name:CAFFREY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3 AUDUBON PLAZA DR STE 550
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1376
Practice Address - Country:US
Practice Address - Phone:502-634-3805
Practice Address - Fax:502-634-9336
Is Sole Proprietor?:No
Enumeration Date:2016-07-14
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71007324A363L00000X
KY3010500363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50112972OtherPASSPORT - NIS
KY218141OtherSIHO - NIS
IN201385710Medicaid
KY000001028611OtherANTHEM - NIS
KY7100414770Medicaid
KYK203310Medicare PIN