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NPI Code Detail

MEDICARE: DR. JENNIFER KING WELDON PH.D.

MEDICARE: DR. JENNIFER KING WELDON PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologistPY7466FL

General Provider Information

NPI Number : 1366562191
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JENNIFER KING WELDON PH.D.
Provider Business Mailing Address
First Line : 2800 UNIVERSITY BLVD N
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32211-3321
Country : US
Telephone Number : 904-256-7180
Fax Number :
Provider Business Practice Location Address
First Line : 2800 UNIVERSITY BLVD N
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32211-3321
Country : US
Telephone Number : 904-256-7180
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2007
Last Update Date : 06/25/2012

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