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General NPI Number Information
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NPI Number | 1083268528
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Entity Type | Individual
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Provider Name | JENNIFER LYNN ULLIMAN FNP-C
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Gender | Female
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Dates
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Enumeration Date | 08/01/2019
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Last Update Date | 06/23/2021
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Provider Practice Location Address
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Address Line | 306 W MAIN ST STE 512
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City | FRANKFORT
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State | KY
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Zip | 40601-1840
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Country | US
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Telephone | 574-546-1900
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Fax | 574-546-1999
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Provider Business Mailing Address
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Address Line | PO BOX 10299
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City | FORT WAYNE
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State | IN
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Zip | 46851-0299
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Country | US
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Telephone | 574-546-1900
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Fax | 574-546-1999
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 71011206A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | AP142506
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3016018
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License Number State | KY
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