Provider Demographics
NPI:1326699844
Name:KORN, JACLYN ANNE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:ANNE
Last Name:KORN
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 1:774 SANDALWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-1644
Mailing Address - Country:US
Mailing Address - Phone:248-535-1176
Mailing Address - Fax:
Practice Address - Street 1:774 SANDALWOOD DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-1644
Practice Address - Country:US
Practice Address - Phone:248-535-1176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704278759363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care