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General NPI Number Information
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NPI Number | 1669685004
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Entity Type | Individual
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Provider Name | JENNIFER ELLEN HETRICK M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 10/10/2022
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Provider Practice Location Address
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Address Line | 885 HIGH ST STE 107
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City | WORTHINGTON
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State | OH
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Zip | 43085-4158
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Country | US
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Telephone | 614-368-7070
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Fax | 614-957-8610
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Provider Business Mailing Address
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Address Line | 6695 THORNE ST
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City | WORTHINGTON
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State | OH
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Zip | 43085-2431
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Country | US
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Telephone | 646-831-8044
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Fax | 614-957-8610
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD108705
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 260281
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35. 089073
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License Number State | OH
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