Provider Demographics
NPI:1871209098
Name:OSBORN, JACKLYN (CRNP)
Entity type:Individual
Prefix:
First Name:JACKLYN
Middle Name:
Last Name:OSBORN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 S JACKSON HWY
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35660-5769
Mailing Address - Country:US
Mailing Address - Phone:256-386-4660
Mailing Address - Fax:256-386-4691
Practice Address - Street 1:1100 S JACKSON HWY STE 104
Practice Address - Street 2:
Practice Address - City:SHEFFIELD
Practice Address - State:AL
Practice Address - Zip Code:35660-5769
Practice Address - Country:US
Practice Address - Phone:256-386-4660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-092944363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care