Provider Demographics
NPI:1710659628
Name:ADAMS, JACQUELYN DENISE (DNP, FNP)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:DENISE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:DNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3325 POCAHONTAS RD
Mailing Address - Street 2:
Mailing Address - City:BAKER CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97814-1464
Mailing Address - Country:US
Mailing Address - Phone:541-519-5024
Mailing Address - Fax:
Practice Address - Street 1:3325 POCAHONTAS RD
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814-1464
Practice Address - Country:US
Practice Address - Phone:541-524-8000
Practice Address - Fax:541-524-7955
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-29
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202110723NP-PP207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine