Provider Demographics
NPI:1699252015
Name:WHITLOCK, JACLYN BROOKE (APRN)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:BROOKE
Last Name:WHITLOCK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:BROOKE
Other - Last Name:CLANCY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6022 MARION ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66218-9254
Mailing Address - Country:US
Mailing Address - Phone:913-213-1352
Mailing Address - Fax:949-561-4135
Practice Address - Street 1:6022 MARION ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66218-9254
Practice Address - Country:US
Practice Address - Phone:913-213-1352
Practice Address - Fax:949-561-4135
Is Sole Proprietor?:No
Enumeration Date:2018-07-27
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-78241-122363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily