MEDICARE: HEATHER JENNINGS NP

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
1	363LF0000X	Family Nurse Practitioner	APRN17768	SC

General Provider Information

NPI Number	:	1609132463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER JENNINGS NP

Provider Business Mailing Address
First Line	:	1235 BERKLEY HILLS PASS
Second Line	:
City	:	EVANS
State	:	GA
Zip	:	30809-7472
Country	:	US
Telephone Number	:	706-829-8032
Fax Number	:

Provider Business Practice Location Address
First Line	:	1235 BERKLEY HILLS PASS
Second Line	:
City	:	EVANS
State	:	GA
Zip	:	30809-7472
Country	:	US
Telephone Number	:	706-829-8032
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2012
Last Update Date	:	04/05/2012

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