Provider Demographics
NPI:1487806634
Name:ENGELSHER, JACLYN (APRN, DOM)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:ENGELSHER
Suffix:
Gender:F
Credentials:APRN, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10605 MEETING STREET
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059
Mailing Address - Country:US
Mailing Address - Phone:502-417-4211
Mailing Address - Fax:
Practice Address - Street 1:10605 MEETING STREET
Practice Address - Street 2:SUITE 102
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059
Practice Address - Country:US
Practice Address - Phone:502-417-4211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAC004171100000X
KY3006428363L00000X
KYAC004/724171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No171100000XOther Service ProvidersAcupuncturist