MEDICARE: JENNIFER KLOSTERMAN DENT FNP

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	363LF0000X	Family Nurse Practitioner	30051	SC

General Provider Information

NPI Number	:	1518784412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER KLOSTERMAN DENT FNP

Provider Business Mailing Address
First Line	:	223 THORNHILL RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29212-1836
Country	:	US
Telephone Number	:	803-422-8137
Fax Number	:

Provider Business Practice Location Address
First Line	:	1333 TAYLOR ST STE 2D
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-2945
Country	:	US
Telephone Number	:	803-438-3800
Fax Number	:

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

Provider Enumeration Date	:	09/23/2024
Last Update Date	:	03/18/2025

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