Provider Demographics
NPI:1861818791
Name:MCCADNEY, JACQUEL (APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:JACQUEL
Middle Name:
Last Name:MCCADNEY
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:JACQUEL
Other - Middle Name:
Other - Last Name:DECEMBLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:1142 AVONDALE AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43607-4163
Mailing Address - Country:US
Mailing Address - Phone:419-276-5415
Mailing Address - Fax:
Practice Address - Street 1:4028 PACKARD RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43612-1936
Practice Address - Country:US
Practice Address - Phone:419-787-7604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-17
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH141677164W00000X
OH410178363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse