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General NPI Number Information
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NPI Number | 1710931548
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Entity Type | Individual
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Provider Name | JENNIFER H PUCKETT MSN, ARNP, CPNP
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Gender | Female
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 02/04/2014
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Provider Practice Location Address
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Address Line | 777 FRANKLIN RD SE
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City | MARIETTA
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State | GA
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Zip | 30067-7803
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Country | US
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Telephone | 770-732-6007
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Fax | 770-732-8242
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Provider Business Mailing Address
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Address Line | 3355 GEORGE BUSBEE PKWY NW APT. 1001
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City | KENNESAW
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State | GA
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Zip | 30144-6823
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Country | US
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Telephone | 214-789-0423
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 628818
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License Number State | TX
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