Provider Demographics
NPI:1831125848
Name:DUKE, JACKIE CAPPS (CRNP)
Entity Type:Individual
Prefix:MS
First Name:JACKIE
Middle Name:CAPPS
Last Name:DUKE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022 1ST ST N
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-8706
Mailing Address - Country:US
Mailing Address - Phone:205-605-2502
Mailing Address - Fax:205-739-2027
Practice Address - Street 1:1022 1ST ST N
Practice Address - Street 2:SUITE 500
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8706
Practice Address - Country:US
Practice Address - Phone:205-605-2502
Practice Address - Fax:205-739-2027
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-066406363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P46922Medicare UPIN