MEDICARE: JESSICA HENDRICKS FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	APRN.CNP.025787	OH

General Provider Information

NPI Number	:	1245876333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA HENDRICKS FNP-C

Provider Business Mailing Address
First Line	:	7430 JEAN DR
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-2659
Country	:	US
Telephone Number	:	513-373-1715
Fax Number	:

Provider Business Practice Location Address
First Line	:	7430 JEAN DR
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-2659
Country	:	US
Telephone Number	:	513-373-1715
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2019
Last Update Date	:	11/23/2019

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