Healthcare Provider Details

I. General information

NPI: 1972106946
Provider Name (Legal Business Name): JACLYN HUSHON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2020
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 BALTIMORE ST
HANOVER PA
17331-4406
US

IV. Provider business mailing address

601 MEMORY LN
YORK PA
17402-2231
US

V. Phone/Fax

Practice location:
  • Phone: 717-812-5130
  • Fax: 717-637-3443
Mailing address:
  • Phone: 717-851-1405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP022169
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: