Healthcare Provider Details

I. General information

NPI: 1962685438
Provider Name (Legal Business Name): JENNIFER J SAVAGE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2007
Last Update Date: 03/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N MAIN STREET
PILOT KNOB MO
63663
US

IV. Provider business mailing address

508 W PINE ST
FARMINGTON MO
63640-1426
US

V. Phone/Fax

Practice location:
  • Phone: 573-546-0184
  • Fax: 573-546-0187
Mailing address:
  • Phone: 573-747-1510
  • Fax: 573-747-1512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number151009
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: