Provider Demographics
NPI:1982029542
Name:CALLAGHAN, JAIME R (DNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:R
Last Name:CALLAGHAN
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 979
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-0979
Mailing Address - Country:US
Mailing Address - Phone:028-878-8330
Mailing Address - Fax:802-878-8344
Practice Address - Street 1:205 CORNERSTONE DR
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-4035
Practice Address - Country:US
Practice Address - Phone:802-878-8330
Practice Address - Fax:802-878-8344
Is Sole Proprietor?:No
Enumeration Date:2014-02-19
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0134133363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1982029542OtherVIRGINIA PREMIER HEALTH PLAN
VA1982029542OtherMULTIPLAN
VA1982029542OtherCORVEL
VA1982029542Medicaid
VA1982029542OtherOPTIMA HEALTH
NC1982029542Medicaid
VA1982029542OtherUSA MANAGED CARE
VA1982029542OtherTRICARE/CHAMPUS
NC1982029542Medicaid