Healthcare Provider Details

I. General information

NPI: 1043058704
Provider Name (Legal Business Name): MCKENNA JACLYN COLE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2024
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 W SPRING ST
TITUSVILLE PA
16354-1655
US

IV. Provider business mailing address

110 N 13TH ST
FRANKLIN PA
16323-2312
US

V. Phone/Fax

Practice location:
  • Phone: 814-827-9675
  • Fax: 814-827-4750
Mailing address:
  • Phone: 814-437-1541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP030121
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: