MEDICARE: JENNIFER HITESHEW CARROLL NP

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	363LW0102X	Women's Health Nurse Practitioner	50090	WY

General Provider Information

NPI Number	:	1942930417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER HITESHEW CARROLL NP

Provider Business Mailing Address
First Line	:	PSC 560 BOX 221
Second Line	:
City	:	APO
State	:	AP
Zip	:	96376-0003
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	U.S NAVAL HOSPITAL
Second Line	:
City	:	CHATAN
State	:	NAKAGAMI DISTRICT
Zip	:	9040103
Country	:	JP
Telephone Number	:	98-971-9355
Fax Number	:

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

Provider Enumeration Date	:	06/16/2022
Last Update Date	:	07/21/2022

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