JACQUELYN E BACCHUS (NPI# 1831380773) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831380773 |
| Entity Type | Individual |
| Full Name | JACQUELYN E BACCHUS |
| Credential | FNP |
| Practice Address |
855 Montgomery Fort Worth TX 76107-2553 |
| Mailing Address |
Po Box 99335 Fort Worth TX 76199-0335 |
| Practice Telephone | 8177352440 |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2015-03-02 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
599838 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
03590 | LA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 340638101 | 05 | |
| TX | BCBS | 8962NL | 01 |
| Street Address |
855 MONTGOMERY |
| City | FORT WORTH |
| State | TX |
| Zip Code | 76107-2553 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194711747 | Victor Lamont Holmes | Physician Assistant | 855 Montgomery, Fort Worth, TX 76107-2553 | 2005-09-20 |
| 1093117848 | Keely Nicole Grant Mirle | Nurse Practitioner | 855 Montgomery, Fort Worth, TX 76107-2553 | 2014-09-24 |
| 1750722187 | Felicia Ann Hoffman | Physician Assistant | 855 Montgomery, Fort Worth, TX 76107-2553 | 2013-07-15 |
| 1194075101 | Christie Peer Shanafelt | Neuromusculoskeletal Medicine & OMM | 855 Montgomery, Fort Worth, TX 76107-2553 | 2012-09-17 |
| 1760737142 | Tomi Omolara Ola-peters | Internal Medicine | 855 Montgomery, Fort Worth, TX 76107-2553 | 2012-07-20 |
| 1386930709 | Crystal Diane Walker | Physician Assistant | 855 Montgomery, Fort Worth, TX 76107-2553 | 2011-06-23 |
| 1881908598 | America E Mcguffee | Physician Assistant | 855 Montgomery, Fort Worth, TX 76107-2553 | 2010-08-05 |
| 1144534173 | James Raymond Leddy | Physician Assistant | 855 Montgomery, Fort Worth, TX 76107-2553 | 2010-08-02 |
| 1548401094 | Yue-qing Tan | Internal Medicine | 855 Montgomery, Fort Worth, TX 76107-2553 | 2009-03-13 |
| 1386892966 | Anjali Kumar | Family Medicine | 855 Montgomery, Fort Worth, TX 76107-2553 | 2008-09-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629683602 | Renovo Wound and Hyperbarics Pllc | Emergency Medicine | 5668 Edwards Ranch Road, Suite 101, Fort Worth, TX 76107 | 2020-09-15 |
| 1669085437 | Ryan Bourgeois | Nurse Practitioner | 2917 Crocket Street, Fort Worth, TX 76107 | 2020-08-31 |
| 1053920546 | Christa Marie Widjaja | Optometrist | 1700 Montgomery St, Fort Worth, TX 76107 | 2020-07-30 |
| 1093351355 | Raymond Iannone | Pharmacist | 850 Montgomery St, Suite #310, Fort Worth, TX 76107 | 2019-11-21 |
| 1053963744 | Cumulus Injury Resolution, Inc. | Chiropractor | 4936 Byers Avenue, Fort Worth, TX 76107 | 2019-07-12 |
| 1770135576 | Shadia Osakwe | Physician Assistant | 855 Montgomery Street, Pediatric Clinic, Fort Worth, TX 76107 | 2019-07-11 |
| 1568945442 | Sachin P Patel | Physical Therapist | 4825 Wellesley St, Fort Worth, TX 76107 | 2018-09-07 |
| 1023594025 | Ftw Pharmacy Services Inc | Durable Medical Equipment & Medical Supplies | 2912 W 6th St Ste 150, Fort Worth, TX 76107 | 2018-07-13 |
| 1669974325 | Helen Williamson Elliott | Counselor | 1751 River Run #217, Fort Worth, TX 76107 | 2018-03-08 |
| 1487156931 | Pelvic Neuromonitoring Pllc | Electrodiagnostic Medicine | 111 Boland St #211, Ft Worth, TX 76107 | 2018-03-01 |
| Find all providers in zip 76107 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417556341 | Sarah R Tabor | Nurse Practitioner | 4819 El Campo Ave, Fort Worth, TX 76107-4917 | 2020-10-21 |
| 1336747963 | Thomas Liles | Nurse Practitioner | 4 Carlson Ct, Fort Worth, TX 76119-5901 | 2020-10-15 |
| 1518565597 | Khyatiben Harsh Parikh | Nurse Practitioner | 8121 Belgian Blue Ct, Fort Worth, TX 76131-1734 | 2020-10-13 |
| 1225645906 | Manju Karki K C | Nurse Practitioner | 4812 Meadow Falls Dr # A, Fort Worth, TX 76244-2308 | 2020-09-28 |
| 1497361778 | Mulikat Dossou | Nurse Practitioner | 8024 Valley Crest Dr, Fort Worth, TX 76120-5651 | 2020-09-22 |
| 1275148793 | Bianca Adrianna Agnello | Nurse Practitioner | 8465 Boat Club Rd Ste 115, Fort Worth, TX 76179-3676 | 2020-09-11 |
| 1356955363 | Alba C. Rivas | Nurse Practitioner | 6958 Legato Ln, Fort Worth, TX 76134-3727 | 2020-09-07 |
| 1043824139 | Traci D Huff | Nurse Practitioner | 7121 Sundance Ln, Fort Worth, TX 76179-2533 | 2020-09-04 |
| 1669085437 | Ryan Bourgeois | Nurse Practitioner | 2917 Crocket Street, Fort Worth, TX 76107 | 2020-08-31 |
| 1619589108 | Megan King | Nurse Practitioner | 9734 N Beach St Ste 100, Fort Worth, TX 76244-6185 | 2020-08-18 |
| Find all providers in FORT WORTH | ||||
| City | FORT WORTH |
| Zip Code | 76107 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.