Provider Demographics
NPI:1083613426
Name:CLINE, JENNIFER ANN (APRN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:CLINE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 GRAND LAKE DR.
Mailing Address - Street 2:
Mailing Address - City:FT. THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-4100
Mailing Address - Country:US
Mailing Address - Phone:859-816-8884
Mailing Address - Fax:
Practice Address - Street 1:343 PIKE ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-2179
Practice Address - Country:US
Practice Address - Phone:859-291-9321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3002725363LA2100X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78027257Medicaid
KYS78413Medicare UPIN
KY78027257Medicaid
KY77105Medicare PIN