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General NPI Number Information
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NPI Number | 1316621436
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Entity Type | Individual
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Provider Name | JENNIFER NICOLE HENNON
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Gender | Female
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Dates
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Enumeration Date | 06/09/2023
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 216 THACKER DR
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City | ROCK SPRING
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State | GA
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Zip | 30739-7200
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Country | US
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Telephone | 866-434-3255
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Fax |
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Provider Business Mailing Address
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Address Line | 10 W MARKET ST STE 2900
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City | INDIANAPOLIS
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State | IN
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Zip | 46204-2964
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Country | US
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Telephone | 866-434-3255
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN184417
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License Number State | GA
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