Provider Demographics
NPI:1699176370
Name:HUEY, JACLYN MICHELLE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:MICHELLE
Last Name:HUEY
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 1:513 PARRISH WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-4549
Mailing Address - Country:US
Mailing Address - Phone:615-330-4805
Mailing Address - Fax:
Practice Address - Street 1:3500 N MOUNT JULIET RD
Practice Address - Street 2:SUITE 201
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-3078
Practice Address - Country:US
Practice Address - Phone:615-758-5672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19144363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily