Provider Demographics
NPI:1922315845
Name:CROSS, JACALYN MARIE (CNP)
Entity Type:Individual
Prefix:
First Name:JACALYN
Middle Name:MARIE
Last Name:CROSS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-1410
Mailing Address - Country:US
Mailing Address - Phone:740-615-1324
Mailing Address - Fax:740-615-1344
Practice Address - Street 1:801 OHIOHEALTH BLVD
Practice Address - Street 2:SUITE 260
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1495
Practice Address - Country:US
Practice Address - Phone:740-615-0500
Practice Address - Fax:740-615-0501
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.11717-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3157524Medicaid
OH3157524Medicaid