Provider Demographics
NPI:1083503445
Name:CALLOW, JACLYN (FNP)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:CALLOW
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 ROYAL BIRKDALE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIANA
Mailing Address - State:OH
Mailing Address - Zip Code:44408-8493
Mailing Address - Country:US
Mailing Address - Phone:330-306-5258
Mailing Address - Fax:
Practice Address - Street 1:107 ROYAL BIRKDALE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIANA
Practice Address - State:OH
Practice Address - Zip Code:44408-8493
Practice Address - Country:US
Practice Address - Phone:330-306-5258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-01
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0039669363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily