Healthcare Provider Details

I. General information

NPI: 1346665056
Provider Name (Legal Business Name): JENNIFER KAY VERNON FNP - C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER KAY BALDWIN FNP - C

II. Dates (important events)

Enumeration Date: 03/04/2014
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 JOE FRANK HARRIS PKWY SE
CARTERSVILLE GA
30120-2129
US

IV. Provider business mailing address

23 LINDA RD SW
EUHARLEE GA
30120-6030
US

V. Phone/Fax

Practice location:
  • Phone: 770-382-1530
  • Fax:
Mailing address:
  • Phone: 678-756-6517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN177268
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN177268
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: