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General NPI Number Information
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NPI Number | 1326608878
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Entity Type | Individual
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Provider Name | JENNIFER LYNN AULTMAN NP-C
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Gender | Female
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Dates
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Enumeration Date | 06/17/2019
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Last Update Date | 06/17/2019
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Provider Practice Location Address
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Address Line | 30 CIRCLE J DR STE 1
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City | LAUREL
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State | MS
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Zip | 39440-1981
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Country | US
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Telephone | 601-425-0092
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Fax | 601-425-0473
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Provider Business Mailing Address
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Address Line | 30 CIRCLE J DR STE 1
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City | LAUREL
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State | MS
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Zip | 39440-1981
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Country | US
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Telephone | 601-425-0092
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Fax | 601-425-0473
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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 | 903398
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License Number State | MS
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