Healthcare Provider Details

I. General information

NPI: 1972722965
Provider Name (Legal Business Name): JENNIFER ANN HUBBARD RN, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 03/05/2021
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 N MAIN ST
EL DORADO KS
67042-2024
US

IV. Provider business mailing address

126 N KARREN CT
WICHITA KS
67212-5968
US

V. Phone/Fax

Practice location:
  • Phone: 316-321-6036
  • Fax: 316-321-6336
Mailing address:
  • Phone: 316-734-3126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number13-90878-022
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number75794
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: