# JACKLYN GANNON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1841078359
- **Gender:** F

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WE0003X | Emergency Registered Nurse | 745153 | NY | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 405347 | NY | Yes |

## Other

- **Enumeration date:** 09/18/2023
- **Last updated:** 10/10/2023