Basic Information
Provider Information | |||||||||
NPI: | 1356489611 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | STEBBINS | ||||||||
FirstName: | JACQUELINE | ||||||||
MiddleName: | IRENE | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | RN | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | TAYLOR | ||||||||
OtherFirstName: | JACQUELINE | ||||||||
OtherMiddleName: | IRENE | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | RN | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 9054 | ||||||||
Address2: |   | ||||||||
City: | GRAY | ||||||||
State: | TN | ||||||||
PostalCode: | 376159054 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4234673600 | ||||||||
FaxNumber: | 4234673696 | ||||||||
Practice Location | |||||||||
Address1: | ROUTE 3 BOX 1700 | ||||||||
Address2: | LEE COUNTY BEHAVIORAL HEALTH SERVICES | ||||||||
City: | JONESVILLE | ||||||||
State: | VA | ||||||||
PostalCode: | 24263 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2763463590 | ||||||||
FaxNumber: | 2763463612 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/01/2007 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 0001195883 | VA | Y |   | Nursing Service Providers | Registered Nurse |   |
No ID Information.