| Doctor Name: | MRS. JACQUELINE SUE ROLLINS |
| NPI Number: | 1205181559 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CP-N |
| License Number: | R0041400 |
| Business Practice Address: | 117 N. Broadway Broken Bow, OK - 747285304 |
| Business Phone Number: | 5802364314 |
| Business Fax Number: | |
| Mailing Address: | 3310 Lamar Ave, PARIS |
| State: | TX |
| Postal Code: | 754605024 |
| Phone Number: | 9039054810 |
| Fax Number: | |
| NPI Enumeration Date: | 07/23/2012 |
| NPI Last Update Date: | 02/23/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | R0041400 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |