Healthcare Provider Details

I. General information

NPI: 1326092024
Provider Name (Legal Business Name): JENNIFER MARY CARRIER-MYERS N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 12/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 KENNEDY DR
TORRINGTON CT
06790-3096
US

IV. Provider business mailing address

200 KENNEDY DR
TORRINGTON CT
06790-3096
US

V. Phone/Fax

Practice location:
  • Phone: 860-482-5384
  • Fax: 860-496-4951
Mailing address:
  • Phone: 860-482-5384
  • Fax: 860-496-4951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SX0200X
TaxonomyOncology Clinical Nurse Specialist
License Number003622
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number003622
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3622
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: