Provider Demographics
NPI:1023242328
Name:HOPKINS, JACQUELINE K (FNP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:K
Last Name:HOPKINS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:K
Other - Last Name:YOUNIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 N OSAGE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64050-2705
Mailing Address - Country:US
Mailing Address - Phone:816-356-2000
Mailing Address - Fax:816-737-1796
Practice Address - Street 1:300 N OSAGE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64050-2705
Practice Address - Country:US
Practice Address - Phone:816-356-2000
Practice Address - Fax:816-737-1796
Is Sole Proprietor?:No
Enumeration Date:2009-05-14
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001014447363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO540568508Medicaid
MO1023242328Medicaid
MO595956103Medicaid
MO010568509Medicaid
MO599225901Medicaid
MO595956202Medicaid
MO595985805Medicaid
MO595956400Medicaid
MO010568509Medicaid
MOP09000004Medicare PIN
MO599225901Medicaid
MO595956400Medicaid
268549Medicare Oscar/Certification
268550Medicare Oscar/Certification
P27000010Medicare PIN
261320Medicare Oscar/Certification
268548Medicare Oscar/Certification
MO1023242328Medicaid