Provider Demographics
NPI:1083801617
Name:JENNINGS, LAURA RUTH (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:RUTH
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 WAHOO VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-3903
Mailing Address - Country:US
Mailing Address - Phone:423-323-9287
Mailing Address - Fax:
Practice Address - Street 1:333 HILL RD
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-4316
Practice Address - Country:US
Practice Address - Phone:423-354-1685
Practice Address - Fax:423-354-1691
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000103502163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool