Provider Demographics
NPI:1649620980
Name:SCHAEFER, JACKLYN KATHLEEN (NP-C, CRNP)
Entity type:Individual
Prefix:
First Name:JACKLYN
Middle Name:KATHLEEN
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:NP-C, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6011 BAPTIST RD STE 200
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15236-3361
Mailing Address - Country:US
Mailing Address - Phone:412-851-1200
Mailing Address - Fax:412-851-1234
Practice Address - Street 1:6011 BAPTIST RD STE 200
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15236-3361
Practice Address - Country:US
Practice Address - Phone:412-851-1200
Practice Address - Fax:412-851-1234
Is Sole Proprietor?:No
Enumeration Date:2016-06-17
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016202363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily