Provider Demographics
NPI:1699740076
Name:GIVIDEN, JACQUELINE K (MD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:K
Last Name:GIVIDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 W ARLINGTON BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-3770
Mailing Address - Country:US
Mailing Address - Phone:252-752-2140
Mailing Address - Fax:252-689-6502
Practice Address - Street 1:2080 W ARLINGTON BLVD STE B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3770
Practice Address - Country:US
Practice Address - Phone:252-752-2140
Practice Address - Fax:252-689-6502
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060188A207L00000X
NC2020-04712207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200512950OtherMDWISE HOOSIER ALLIANCE
IN2684317000OtherPASSPORT ADVANTAGE
KY000000361232OtherANTHEM
IN000000361232OtherUNICARE
KY7100082610Medicaid
IN000000361232OtherINDIANA COMPREHENSIVE
IN000000361232OtherANTHEM
IN200512950OtherMANAGED HEALTH SERVICES
INP00265884OtherRAILROAD MEDICARE
IN000000361232OtherHEALTHLINK
IN000000361232OtherANTHEM SENIOR ADVANTAGE
IN000000361232OtherONE NATION BENEFIT
IN000000361232OtherANTHEM MEDICAID
IN200512950Medicaid
50009617OtherPASSPORT
IN129703800OtherBLACK LUNG PROGRAM
IN129703800OtherUS DEPT OF LABOR
IN134960HOtherUNICARE MEDICARE
50009617OtherPASSPORT
IN200512950Medicaid