Provider Demographics
NPI:1659677748
Name:WARD, JACQUELINE K (NP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:K
Last Name:WARD
Suffix:
Gender:F
Credentials:NP
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 29039
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-9039
Mailing Address - Country:US
Mailing Address - Phone:602-256-2525
Mailing Address - Fax:602-256-0795
Practice Address - Street 1:3300 N CENTRAL AVE
Practice Address - Street 2:STE 2550
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2501
Practice Address - Country:US
Practice Address - Phone:602-256-2525
Practice Address - Fax:602-256-0795
Is Sole Proprietor?:No
Enumeration Date:2011-02-07
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5073363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care