Healthcare Provider Details

I. General information

NPI: 1841912557
Provider Name (Legal Business Name): JENNA ROSE MCDONALD HAUPERT APRN, DNP, AG-ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 11/11/2022
Certification Date: 11/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST
LEXINGTON KY
40536-3008
US

IV. Provider business mailing address

3428 OAKBROOK DR
LEXINGTON KY
40515-1396
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-9057
  • Fax: 859-323-9502
Mailing address:
  • Phone: 859-608-8543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberPENDING
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number3018540
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: