Provider Demographics
NPI:1861671513
Name:MYERS, JACQUELINE SUE (NP)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:SUE
Last Name:MYERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 W MAIN ST
Mailing Address - Street 2:BHS/SCHOOL BASED HEALTH CENTER
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3487
Mailing Address - Country:US
Mailing Address - Phone:508-790-7200
Mailing Address - Fax:508-790-3280
Practice Address - Street 1:744 W MAIN ST
Practice Address - Street 2:BHS/SCHOOL BASED HEALTH CENTER
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3487
Practice Address - Country:US
Practice Address - Phone:508-790-7200
Practice Address - Fax:508-790-3280
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA109102363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics