Provider Demographics
NPI:1134754591
Name:HARTMAN, JACQUELINE BURT (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:BURT
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 COPPER CV
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NC
Mailing Address - Zip Code:28120-9170
Mailing Address - Country:US
Mailing Address - Phone:225-717-7755
Mailing Address - Fax:
Practice Address - Street 1:100 COPPER CV
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NC
Practice Address - Zip Code:28120-9170
Practice Address - Country:US
Practice Address - Phone:225-717-7755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-05
Last Update Date:2023-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5013676363LP0808X
NC327144363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty