Provider Demographics
NPI:1114593357
Name:KUMAR, JACLYN (NP)
Entity Type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:
Last Name:KUMAR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:
Other - Last Name:SCHULTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:65 W 95TH ST APT 2C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6796
Mailing Address - Country:US
Mailing Address - Phone:865-356-1863
Mailing Address - Fax:
Practice Address - Street 1:99 TERRACE VIEW AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-5079
Practice Address - Country:US
Practice Address - Phone:865-356-1863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-28
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY879226-01163WS0200X
WARN60992265163WS0200X
NY352140363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WS0200XNursing Service ProvidersRegistered NurseSchool