Provider Demographics
NPI:1326036658
Name:GLENN, JENNIFER K (ARNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:K
Last Name:GLENN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 7TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1711
Mailing Address - Country:US
Mailing Address - Phone:205-638-2953
Mailing Address - Fax:205-638-3925
Practice Address - Street 1:1600 7TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1711
Practice Address - Country:US
Practice Address - Phone:205-638-2953
Practice Address - Fax:205-638-3925
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1105856163W00000X
KY20041080363LP0200X
KY4540P363L00000X
AL1-149075363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78014917Medicaid
KY1105856OtherKY BD OF NURSING
KY4540POtherKENTUCKY BD OF NURSING
KY1105856OtherKY BD OF NURSING
Q51645Medicare UPIN