MEDICARE: JENNIFER L DEVINE APRN

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	363LA2100X	Acute Care Nurse Practitioner	3014013	KY
2	363LA2100X	Acute Care Nurse Practitioner	TEMP333392	AZ

General Provider Information

NPI Number	:	1346884095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER L DEVINE APRN

Provider Business Mailing Address
First Line	:	1200 DEEP CREEK RD
Second Line	:
City	:	PERRYVILLE
State	:	KY
Zip	:	40468-9602
Country	:	US
Telephone Number	:	859-230-5203
Fax Number	:

Provider Business Practice Location Address
First Line	:	217 S 3RD ST
Second Line	:
City	:	DANVILLE
State	:	KY
Zip	:	40422-1823
Country	:	US
Telephone Number	:	859-239-1000
Fax Number	:

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

Provider Enumeration Date	:	11/05/2019
Last Update Date	:	01/08/2026

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