Provider Demographics
NPI:1073343091
Name:MCCONNAUGHEY, JACQUELYNN R
Entity type:Individual
Prefix:MRS
First Name:JACQUELYNN
Middle Name:R
Last Name:MCCONNAUGHEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45123-1333
Mailing Address - Country:US
Mailing Address - Phone:937-509-0542
Mailing Address - Fax:
Practice Address - Street 1:2107 ROMBACH AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2099
Practice Address - Country:US
Practice Address - Phone:937-383-1040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0036944363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner