Provider Demographics
NPI:1467759035
Name:ALEXANDER, JACLYN HALEY (APRN)
Entity Type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:HALEY
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:HALEY
Other - Last Name:BENNINGFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:4123 DUTCHMANS LN
Practice Address - Street 2:STE. 300
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4707
Practice Address - Country:US
Practice Address - Phone:502-899-6700
Practice Address - Fax:502-899-6740
Is Sole Proprietor?:No
Enumeration Date:2011-02-17
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006642363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100164510Medicaid
KYK018461Medicare Oscar/Certification