Provider Demographics
NPI:1295102101
Name:DELPRETE, JACKLYN (NP)
Entity type:Individual
Prefix:
First Name:JACKLYN
Middle Name:
Last Name:DELPRETE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 SUNRISE DR
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:PA
Mailing Address - Zip Code:18414-9113
Mailing Address - Country:US
Mailing Address - Phone:570-445-5177
Mailing Address - Fax:
Practice Address - Street 1:247 MAIN ST
Practice Address - Street 2:
Practice Address - City:DICKSON CITY
Practice Address - State:PA
Practice Address - Zip Code:18519-1641
Practice Address - Country:US
Practice Address - Phone:570-291-4180
Practice Address - Fax:570-586-3953
Is Sole Proprietor?:No
Enumeration Date:2015-08-26
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015081363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily