Provider Demographics
NPI:1871557058
Name:MARTIN, JACKIE BRATTON (RNC, MS, NNP)
Entity type:Individual
Prefix:MRS
First Name:JACKIE
Middle Name:BRATTON
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RNC, MS, NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 HILLVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-8070
Mailing Address - Country:US
Mailing Address - Phone:540-977-2022
Mailing Address - Fax:
Practice Address - Street 1:1906 BELLEVIEW AVE SE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1838
Practice Address - Country:US
Practice Address - Phone:540-981-8124
Practice Address - Fax:540-983-1243
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0017137194363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal