| Primary Care Clinic Of Jackson | |
|
54 Exeter Rd Ste B Jackson TN 38305-1985 | |
| (731) 935-9463 | |
| Not Available |
| Full Name | Primary Care Clinic Of Jackson |
|---|---|
| Speciality | Clinic/Center |
| Location | 54 Exeter Rd Ste B, Jackson, Tennessee |
| Authorized Official Name and Position | Kathy Michelle O'connor-wray (FNP, OWNER) |
| Authorized Official Contact | 7312656197 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Primary Care Clinic Of Jackson 8 Stonebridge Blvd Ste M Jackson TN 38305-2178 Ph: (731) 265-6197 | Primary Care Clinic Of Jackson 54 Exeter Rd Ste B Jackson TN 38305-1985 Ph: (731) 935-9463 |
| NPI Number | 1609309855 |
|---|---|
| Provider Enumeration Date | 04/05/2017 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 6901173657 |
|---|---|
| Medicare Enrollment ID | O20170530002269 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609309855 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 000896897 (Tennessee) | Primary |
| Provider Name | Carol A Luckey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003858150 PECOS PAC ID: 4688645609 Enrollment ID: I20040807000230 |
| Provider Name | Kathy M O'connor-wray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528241999 PECOS PAC ID: 5193971174 Enrollment ID: I20120807000349 |
| Provider Name | Rebecca Burrow |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316513682 PECOS PAC ID: 6204233778 Enrollment ID: I20210927000306 |
| Provider Name | Sara E Ward |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992376115 PECOS PAC ID: 7618375882 Enrollment ID: I20211004000554 |
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