Provider Demographics
NPI:1124303128
Name:FITCHETT, JACLYN L (PPCNP-BC)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:L
Last Name:FITCHETT
Suffix:
Gender:F
Credentials:PPCNP-BC
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:L
Other - Last Name:PAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PPCNP-BC
Mailing Address - Street 1:PO BOX 780
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26507-0780
Mailing Address - Country:US
Mailing Address - Phone:304-293-7401
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506-7911
Practice Address - Country:US
Practice Address - Phone:304-598-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-21
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV69696363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics