Provider Demographics
NPI:1306192729
Name:CURNUTT, JACLYN DAWN (APN)
Entity Type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:DAWN
Last Name:CURNUTT
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MRS
Other - First Name:JACLYN
Other - Middle Name:
Other - Last Name:CURNUTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APN
Mailing Address - Street 1:3801 S NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5210
Mailing Address - Country:US
Mailing Address - Phone:417-269-3000
Mailing Address - Fax:
Practice Address - Street 1:3825 S. NOLAN RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-03
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012008767363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily