Provider Demographics
NPI:1609803550
Name:NORTH, JACQUELINE CHAPMAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:CHAPMAN
Last Name:NORTH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 MAUPIN CIR
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-3781
Mailing Address - Country:US
Mailing Address - Phone:931-680-7576
Mailing Address - Fax:931-536-4346
Practice Address - Street 1:118 MAUPIN CIR
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-3781
Practice Address - Country:US
Practice Address - Phone:931-680-7576
Practice Address - Fax:931-536-4346
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000001565103TC0700X
KY1299103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00060116Medicare ID - Type UnspecifiedRRB MEDICARE
TN3683491Medicaid
TN3683491Medicare ID - Type Unspecified
KY0793502Medicare ID - Type Unspecified