Provider Demographics
NPI:1619489689
Name:EASLER, JACKQUELINE SUE (APRN)
Entity Type:Individual
Prefix:
First Name:JACKQUELINE
Middle Name:SUE
Last Name:EASLER
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 1:2135 VILLAGE RUN
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-4046
Mailing Address - Country:US
Mailing Address - Phone:270-903-3168
Mailing Address - Fax:
Practice Address - Street 1:1000 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-8715
Practice Address - Country:US
Practice Address - Phone:270-689-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-31
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011859363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily