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NPI Code Detail

MEDICARE: JENNIFER K MCCULLEN

MEDICARE: JENNIFER K MCCULLEN
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
11041C0700XClinical Social WorkerP019898NC

General Provider Information

NPI Number : 1427830140
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER K MCCULLEN
Provider Business Mailing Address
First Line : 2000 S MAIN ST
Second Line :
City : WAKE FOREST
State : NC
Zip : 27587-9335
Country : US
Telephone Number : 919-417-2693
Fax Number :
Provider Business Practice Location Address
First Line : 2000 S MAIN ST
Second Line :
City : WAKE FOREST
State : NC
Zip : 27587-9335
Country : US
Telephone Number : 919-417-2693
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2023
Last Update Date : 10/17/2023

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Directions to “ JENNIFER K MCCULLEN ” Practice Location

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