Provider Demographics
NPI:1427055334
Name:GAFFNEY, JACQUELINE G (PA-C)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:G
Last Name:GAFFNEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:G
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2802 OAK VIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-5604
Mailing Address - Country:US
Mailing Address - Phone:402-334-7546
Mailing Address - Fax:402-334-8627
Practice Address - Street 1:2802 OAK VIEW DRIVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-5604
Practice Address - Country:US
Practice Address - Phone:402-334-7546
Practice Address - Fax:402-334-8627
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001095363A00000X
NE622363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA04011OtherWELLMARK BCBS
NE37752OtherBCBS NE
IAI7690OtherIOWA MEDICARE
NE96817OtherWELLMARK BCBS
IA04011OtherWELLMARK BCBS
R81929Medicare UPIN
970008761Medicare PIN