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General NPI Number Information
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NPI Number | 1164895363
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Entity Type | Individual
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Provider Name | JENNA CRAVENS FNP
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Gender | Female
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Dates
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Enumeration Date | 11/10/2015
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Last Update Date | 06/06/2018
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Provider Practice Location Address
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Address Line | 1602A N MAIN ST
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City | MOUNTAIN GROVE
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State | MO
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Zip | 65711
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Country | US
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Telephone | 417-269-2350
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Fax | 417-926-5626
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Provider Business Mailing Address
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Address Line | PO BOX 4046
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City | SPRINGFIELD
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State | MO
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Zip | 65808-4046
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Country | US
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Telephone | 417-269-5712
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Fax | 417-269-7567
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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 | 2015028254
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License Number State | MO
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