Provider Demographics
NPI:1861487746
Name:PERCY, JACQUELINE
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:PERCY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 118 BOX 714
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09137
Mailing Address - Country:DE
Mailing Address - Phone:01149656-169-5172
Mailing Address - Fax:
Practice Address - Street 1:BITBURG HOSPITAL
Practice Address - Street 2:
Practice Address - City:BITBURG AIR BASE
Practice Address - State:BITBURG
Practice Address - Zip Code:95634
Practice Address - Country:DE
Practice Address - Phone:01149656-169-3456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0055855207P00000X, 207Q00000X
IN01057679A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine