Provider Demographics
NPI:1750922779
Name:MCGINNIS, JACQUELYN DWELLE (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:DWELLE
Last Name:MCGINNIS
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:PO BOX 744786
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-4786
Mailing Address - Country:US
Mailing Address - Phone:704-865-3848
Mailing Address - Fax:
Practice Address - Street 1:400 E STATESVILLE AVE STE 200
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-2588
Practice Address - Country:US
Practice Address - Phone:704-360-8486
Practice Address - Fax:704-230-4674
Is Sole Proprietor?:No
Enumeration Date:2019-10-01
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5012332363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health