Healthcare Provider Details

I. General information

NPI: 1083613426
Provider Name (Legal Business Name): JENNIFER ANN CLINE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 09/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 PIKE ST
COVINGTON KY
41011-2179
US

IV. Provider business mailing address

26 GRAND LAKE DR.
FT. THOMAS KY
41075-4100
US

V. Phone/Fax

Practice location:
  • Phone: 859-291-9321
  • Fax:
Mailing address:
  • Phone: 859-816-8884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number3002725
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number3002725
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: