Provider Demographics
NPI:1275913626
Name:JACKIE BURGESS MIDWIFERY
Entity type:Organization
Organization Name:JACKIE BURGESS MIDWIFERY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MIDWIFE
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:RENAE
Authorized Official - Last Name:BURGESS
Authorized Official - Suffix:
Authorized Official - Credentials:LM, CPM
Authorized Official - Phone:239-699-8718
Mailing Address - Street 1:7693 S. VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-1114
Mailing Address - Country:US
Mailing Address - Phone:775-430-9241
Mailing Address - Fax:775-418-0430
Practice Address - Street 1:7693 S. VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-1114
Practice Address - Country:US
Practice Address - Phone:775-430-9241
Practice Address - Fax:775-418-0430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-01
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW304305S00000X
176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
No305S00000XManaged Care OrganizationsPoint of Service