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General NPI Number Information
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NPI Number | 1346011905
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Entity Type | Individual
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Provider Name | JENNIFER HUPP
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Gender | Female
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Dates
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Enumeration Date | 01/12/2024
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Last Update Date | 06/27/2024
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Provider Practice Location Address
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Address Line | 406 N GOLIAD ST
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City | ROCKWALL
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State | TX
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Zip | 75087-2726
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Country | US
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Telephone | 614-260-1673
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 PRESIDENT GEORGE BUSH HWY APT 35001
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City | ROWLETT
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State | TX
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Zip | 75088-1922
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Country | US
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Telephone | 614-260-1673
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 1159525
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN.492493
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License Number State | OH
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