Provider Demographics
NPI:1477920247
Name:WHITE, JACLYN (AGPCNP, MSN)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:AGPCNP, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 DUKE MEDICINE CIRCLE
Mailing Address - Street 2:CLINIC 2-2
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710
Mailing Address - Country:US
Mailing Address - Phone:919-681-9156
Mailing Address - Fax:919-660-8608
Practice Address - Street 1:20 DUKE MEDICINE CIR
Practice Address - Street 2:CLINIC 2-2
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-7340
Practice Address - Country:US
Practice Address - Phone:919-681-9156
Practice Address - Fax:919-660-8608
Is Sole Proprietor?:No
Enumeration Date:2015-08-27
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC241351363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner