Provider Demographics
NPI:1942203997
Name:MYERS, JACQUELINE M (AND, BSN, MS, ANP)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:M
Last Name:MYERS
Suffix:
Gender:F
Credentials:AND, BSN, MS, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1153 E MAIN ST
Mailing Address - Street 2:PO BOX 2563
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-4056
Mailing Address - Country:US
Mailing Address - Phone:740-687-8990
Mailing Address - Fax:740-687-8230
Practice Address - Street 1:618 PLEASANTVILLE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3312
Practice Address - Country:US
Practice Address - Phone:740-681-9020
Practice Address - Fax:740-681-9112
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0337916-21363L00000X
OHCOA.08314-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2963173Medicaid
OHP00732832OtherMEDICARE RAILROAD
OHNP30071Medicare PIN