JACKLYN GANNON
NPI 1841078359
Nurse Practitioner - Psychiatric/Mental Health in Stony Brook, NY

Q: What is Jacklyn Gannon's NPI number?

The NPI number for Jacklyn Gannon is 1841078359. It was assigned to this individual provider in the NPPES registry on September 18, 2023.

Q: What is Jacklyn Gannon's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Q: When was this NPI record last updated?

The NPPES record for Jacklyn Gannon was last updated on October 10, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since September 18, 2023PECOS EnrolledAccepts Medicare Assignment

101 NICOLLS RD, STONY BROOK, NY 11794(631) 638-1036 Get Directions Write a Review

NPPES record last updated: October 10, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Jacklyn Gannon NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACKLYN GANNON (NPI 1841078359) is an individual psychiatric/mental health provider in Stony Brook, New York, licensed in New York (405347) and active in the NPI registry since September 2023. She is enrolled in Medicare PECOS and is a graduate of Other (2023).

NPPES Registry Identity

NPI1841078359

Entity TypeIndividualFemale

Primary Taxonomy363LP0808X

Provider Legal NameJACKLYN GANNON

Location Address101 NICOLLS RDStony Brook, NY 11794-0001

Mailing Address55c Commodore LnWest Babylon, NY 11704-8203 · (631) 560-0970

Phone(631) 638-1036

Sole ProprietorYes

Medical School CMSOtherGraduated 2023

Enumeration DateSeptember 18, 2023

Last NPPES UpdateOctober 10, 2023

NPPES CertifiedOctober 10, 2023

✔ NPI 1841078359 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LP0808X

License✔ Licensed in NY · 405347

Also ListedRegistered Nurse · EmergencyTaxonomy 163WE0003X · License 745153 (NY)

101 NICOLLS RD, Stony Brook, NY 11794

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Jacklyn Gannon is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2163952631

PECOS Enrollment IDI20250213000324

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 11794 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$105.06 typical visit price

range $67.40 – $203.53

Typical copayment $26.26 (range $16.85 – $50.88)

Most-billed visit code 99203

Established Patient

$117.62 typical visit price

range $21.66 – $164.45

Typical copayment $29.40 (range $5.41 – $41.11)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NARINDER SINGH M.D.

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