Provider Demographics
NPI:1740464130
Name:BUZZELL, JACLYNE A (NP)
Entity type:Individual
Prefix:
First Name:JACLYNE
Middle Name:A
Last Name:BUZZELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 950244
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0244
Mailing Address - Country:US
Mailing Address - Phone:502-953-4700
Mailing Address - Fax:502-772-8189
Practice Address - Street 1:2500 W MARKET ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40212-1541
Practice Address - Country:US
Practice Address - Phone:502-778-8400
Practice Address - Fax:502-996-8309
Is Sole Proprietor?:No
Enumeration Date:2007-12-21
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007767363LA2200X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00613332OtherRAILROAD MEDICARE PIN
KY7100245250Medicaid
KYK088056Medicare PIN
KYK088057Medicare PIN
3341487Medicare PIN
KYK088054Medicare PIN
KYK088051Medicare PIN
KYK088052Medicare PIN