Degolyer, Jacki Sue

Degolyer, Jacki Sue is an individual health care provider with primary practice located at 4235 S New Hope Rd Ste A , Gastonia NC 28056-8453. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Family, Physician Assistants & Advanced Practice Nursing Providers / Primary Care. Physician Assistants & Advanced Practice Nursing Providers / Primary Care is her primary health care specialty. Degolyer, Jacki Sue can be contacted via phone (704) 834-2450.

Contact Information

Primary practice address
4235 S New Hope Rd Ste A Gastonia NC 28056-8453
Phone: (704) 834-2450
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 0996679-NP Colorado
Physician Assistants & Advanced Practice Nursing Providers / Primary Care 363LP2300X 5019545 North Carolina

Profile Details

NPI number 1356912497
LBN Legal business name Degolyer, Jacki Sue
Credentials Family Nurse Practitioner (FNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 9th, 2021
Last updated May 8th, 2024 - about 6 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1356912497 NPPES
Colorado Other 0175594 COLORADO REGISTERED NURSE LICENSE
Colorado Other 0996679-NP COLORADO REGISTERED NURSE LICENSE
Colorado Other 227042 COLORADO REGISTERED NURSE LICENSE
Colorado Other 364412 COLORADO REGISTERED NURSE LICENSE
Colorado Other 5019545 COLORADO REGISTERED NURSE LICENSE

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