Provider Demographics
NPI:1225028525
Name:STODDARD, JENNIFER KATE (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:KATE
Last Name:STODDARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:STODDARD
Other - Last Name:KLENZAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:293 OLMSTED BLVD
Mailing Address - Street 2:STE 7
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-9023
Mailing Address - Country:US
Mailing Address - Phone:910-295-3344
Mailing Address - Fax:910-295-3165
Practice Address - Street 1:293 OLMSTED BLVD
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-9023
Practice Address - Country:US
Practice Address - Phone:910-295-3344
Practice Address - Fax:910-295-3165
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900902207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902172Medicaid
I44778Medicare UPIN
NC5902172Medicaid