Provider Demographics
NPI:1336035641
Name:CLAYCOMB, JESSICA KAYE (FNP-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:KAYE
Last Name:CLAYCOMB
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 BEAVER DAM RD
Mailing Address - Street 2:
Mailing Address - City:CLAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16625-9105
Mailing Address - Country:US
Mailing Address - Phone:310-871-5590
Mailing Address - Fax:
Practice Address - Street 1:365 BEAVER DAM RD
Practice Address - Street 2:
Practice Address - City:CLAYSBURG
Practice Address - State:PA
Practice Address - Zip Code:16625-9105
Practice Address - Country:US
Practice Address - Phone:310-871-5590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN528693L363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily