Healthcare Provider Details

I. General information

NPI: 1316572266
Provider Name (Legal Business Name): JESSICA CLEARY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2020
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1078 S WASHINGTON AVE
SCRANTON PA
18505-3812
US

IV. Provider business mailing address

PO BOX 746722
ATLANTA GA
30374-6722
US

V. Phone/Fax

Practice location:
  • Phone: 570-241-0500
  • Fax: 570-491-8012
Mailing address:
  • Phone: 312-733-9730
  • Fax: 312-929-0373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP022437
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: