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 1:4010 DUPONT CIR STE L07
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4812
Mailing Address - Country:US
Mailing Address - Phone:502-895-6559
Mailing Address - Fax:502-895-8994
Practice Address - Street 1:4010 DUPONT CIR STE L07
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4812
Practice Address - Country:US
Practice Address - Phone:502-895-6559
Practice Address - Fax:502-895-8994
Is Sole Proprietor?:No
Enumeration Date:2011-02-17
Last Update Date:2024-08-06
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