MEDICARE: JENNIFER MICHELE RUDDER

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	390200000X	Student in an Organized Health Care Education/Training Program		AR

General Provider Information

NPI Number	:	1700711074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MICHELE RUDDER

Provider Business Mailing Address
First Line	:	6215 IRONWOOD LN
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72916-8842
Country	:	US
Telephone Number	:	479-719-6829
Fax Number	:

Provider Business Practice Location Address
First Line	:	6215 IRONWOOD LN
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72916-8842
Country	:	US
Telephone Number	:	479-719-6829
Fax Number	:

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

Provider Enumeration Date	:	06/16/2026
Last Update Date	:	06/16/2026

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Directions to “ JENNIFER MICHELE RUDDER ” Practice Location

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