Healthcare Provider Details

I. General information

NPI: 1023527934
Provider Name (Legal Business Name): JENNIFER ANNE HOVIS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2017
Last Update Date: 09/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HCR 2 5355
GREENVILLE MO
63944
US

IV. Provider business mailing address

HCR 2 5355
GREENVILLE MO
63944
US

V. Phone/Fax

Practice location:
  • Phone: 573-979-3109
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2017033625
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: