Provider Demographics
NPI:1366677981
Name:WEST, JACLYN SUE (FNP-BC, DC)
Entity type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:SUE
Last Name:WEST
Suffix:
Gender:
Credentials:FNP-BC, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4405 FEDERAL RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14487-9570
Mailing Address - Country:US
Mailing Address - Phone:585-734-0059
Mailing Address - Fax:
Practice Address - Street 1:613 PITTSFORD VICTOR RD
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-3933
Practice Address - Country:US
Practice Address - Phone:585-924-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0117861111N00000X
NYF354545-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor