Healthcare Provider Details

I. General information

NPI: 1295071041
Provider Name (Legal Business Name): JENNIFER L MCGUIRE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER CHRISTY

II. Dates (important events)

Enumeration Date: 12/26/2012
Last Update Date: 05/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2754 W REPUBLIC RD
SPRINGFIELD MO
65807-3901
US

IV. Provider business mailing address

2754 W REPUBLIC RD
SPRINGFIELD MO
65807-3901
US

V. Phone/Fax

Practice location:
  • Phone: 417-351-2609
  • Fax:
Mailing address:
  • Phone: 417-351-2609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2013001558
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number2013001558
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: