Healthcare Provider Details

I. General information

NPI: 1225378904
Provider Name (Legal Business Name): JENNIFER MARIE MCDOWELL ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2013
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 PADGETT DR
CLINTON KY
42031-1313
US

IV. Provider business mailing address

415 W GOLF RD STE 26
ARLINGTON HEIGHTS IL
60005-3923
US

V. Phone/Fax

Practice location:
  • Phone: 270-653-5558
  • Fax:
Mailing address:
  • Phone: 224-777-8034
  • Fax: 224-236-4900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number17380
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number3014697
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: