Provider Demographics
NPI:1104399278
Name:KILLIPS, JENNIFER T (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:T
Last Name:KILLIPS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:T
Other - Last Name:SCARLETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:819 WORCESTER ST STE 1
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01151-1045
Mailing Address - Country:US
Mailing Address - Phone:413-304-2501
Mailing Address - Fax:413-789-0290
Practice Address - Street 1:819 WORCESTER ST STE 1
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01151-1045
Practice Address - Country:US
Practice Address - Phone:413-304-2501
Practice Address - Fax:413-789-0290
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2306267363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily