Individual provider · Type 1 NPI
Jacklyn Gannon
Psychiatric/Mental Health Nurse Practitioner · Stony Brook, NY
NPI number
1841078359
Active
Practice location
101 Nicolls Rd
Stony Brook, NY 11794-0001
Mailing address
55C Commodore Ln
West Babylon, NY 11704-8203
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Emergency Registered Nurse | 163WE0003X | 745153 (NY) |
| Psychiatric/Mental Health Nurse Practitioner Primary | 363LP0808X | 405347 (NY) |
Psychiatric/Mental Health Nurse Practitioner: Definition to come...
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About NPI 1841078359
Jacklyn Gannon's National Provider Identifier is 1841078359, issued on Sep 18, 2023. The primary taxonomy on file is Psychiatric/Mental Health Nurse Practitioner (363LP0808X), and the practice location is in Stony Brook, NY. The record was last updated on Oct 10, 2023.