Provider Demographics
NPI:1699136929
Name:HESS, JACKLYN T (APRN)
Entity type:Individual
Prefix:
First Name:JACKLYN
Middle Name:T
Last Name:HESS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 E DIXIE AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-1408
Mailing Address - Country:US
Mailing Address - Phone:270-505-2129
Mailing Address - Fax:
Practice Address - Street 1:109 E DIXIE AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-1408
Practice Address - Country:US
Practice Address - Phone:270-505-2129
Practice Address - Fax:844-905-1534
Is Sole Proprietor?:No
Enumeration Date:2016-03-15
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010160363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily