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General NPI Number Information
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NPI Number | 1548777014
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Entity Type | Individual
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Provider Name | JENNA E. TARTER
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Gender | Female
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Dates
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Enumeration Date | 01/05/2018
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Last Update Date | 01/30/2024
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Provider Practice Location Address
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Address Line | 615 7TH AVE
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City | BOWLING GREEN
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State | KY
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Zip | 42101-6921
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Country | US
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Telephone | 270-846-4800
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Fax | 270-846-4828
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Provider Business Mailing Address
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Address Line | PO BOX 776879
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City | CHICAGO
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State | IL
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Zip | 60677-6879
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Country | US
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Telephone |
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Fax | 502-272-5116
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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 | 3012043
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License Number State | KY
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