Healthcare Provider Details

I. General information

NPI: 1326650789
Provider Name (Legal Business Name): JENNIFER R PUTNAM-SCOTT MSN, AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

569 SKYLINE DR
JACKSON TN
38301-3911
US

IV. Provider business mailing address

PO BOX 505351
SAINT LOUIS MO
63150-5351
US

V. Phone/Fax

Practice location:
  • Phone: 731-664-7395
  • Fax: 731-660-8739
Mailing address:
  • Phone: 731-660-8730
  • Fax: 731-660-8739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberINPROCESS
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number28168
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: