Provider Demographics
NPI:1700321387
Name:SEAY, JACLYN A (CRNA)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:A
Last Name:SEAY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:
Other - Last Name:BURLESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-588-0328
Mailing Address - Fax:502-588-0328
Practice Address - Street 1:530 S JACKSON ST RM C2A01
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1675
Practice Address - Country:US
Practice Address - Phone:502-852-5851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-05
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9309418367500000X
KY3016259367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered