MRS. JACKIE GWENN TAWODA (FNP) – Family Nurse Practitioner, NPI 1487368049

MRS. JACKIE GWENN TAWODA (FNP) is a healthcare provider. based in Ewing, Virginia. specializing in NURSE PRACTITIONER. They hold the professional credentials FNP. They hold a License No. 3018842 (KY). The NPI Number for MRS. JACKIE GWENN TAWODA (FNP) is 1487368049

Main info

Female
4 Years Of Experience
Accepts Medicare Assignment
Name
MRS. JACKIE GWENN TAWODA (FNP)
NPI
1487368049
Phone
Not provided
Address
268 SADIE LN
Enumeration Date
9 January 2023
Last Update Date
21 October 2024

Doctor Profile

Medical School Name
LINCOLN MEMORIAL UNIVERSITY MEDICAL DEPARTMENT
Secondary Phone
6063373051251
Graduation Year
2022 (4 years ago)
PAC ID
1658745401
Group Practice PAC ID
5698009157
Professional Enrollment ID
I20230320000556
Address ID
KY409771452PI850XXAVEX300
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience30
Completeness75
Years active:3State licenses:1Digital endpointsOther names

7,343 NURSE PRACTITIONER in KY

Provider Addresses for MRS. JACKIE GWENN TAWODA (FNP)

  • 268 SADIE LN

    EWING, VA 242488797

    Phone:

    Type: Mailing

  • 850 RIVERVIEW AVE

    PINEVILLE, KY 409771452

    Phone: (606) 654-4526

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 2 Open Payments records for all available years, with a total value of $31.

Total Amount is formed as General ($31) + Research ($0) + Ownership ($0) = $31.

Last reported payment date: 2024-11-13 • Largest payer in this snapshot: Alkermes, Inc. ($16).

Total Amount

$31

General + Research + Ownership

Payments

2

Total payment records

General Amount

$31

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-11-13

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2023-03-20

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20230320000556INurse PractitionerKYTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 24248)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 5698009157View full group profile
NameSpecialtyState
Nurse PractitionerKY
Orthopedic SurgeryNC
Nurse PractitionerKY
U R O L O G YKY
Nurse PractitionerTN
Nurse PractitionerOK
Nurse PractitionerKY
Nurse PractitionerKY
Nurse PractitionerKY
-TN

Reviews

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Frequently asked questions

What unique ID ties claims to MRS. JACKIE GWENN TAWODA (FNP)?
NPI 1487368049 is assigned to MRS. JACKIE GWENN TAWODA (FNP) under the national enumeration system.
Does this profile mean MRS. JACKIE GWENN TAWODA (FNP) is currently active?
Yes — MRS. JACKIE GWENN TAWODA (FNP) appears active in the national provider directory.
What kind of provider is MRS. JACKIE GWENN TAWODA (FNP)?
The page reflects Family Nurse Practitioner for MRS. JACKIE GWENN TAWODA (FNP). Clinical services aligned with this taxonomy classification.
What location metadata exists for MRS. JACKIE GWENN TAWODA (FNP)?
The page summarizes Ewing, Virginia for MRS. JACKIE GWENN TAWODA (FNP); expand the address list for detail.
Does Medicare enrollment show here?
Medicare enrollment screens are separate from the basic NPI extract shown here.

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