Provider Demographics
NPI:1326092024
Name:CARRIER-MYERS, JENNIFER MARY (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARY
Last Name:CARRIER-MYERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-3096
Mailing Address - Country:US
Mailing Address - Phone:860-482-5384
Mailing Address - Fax:860-496-4951
Practice Address - Street 1:200 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-3096
Practice Address - Country:US
Practice Address - Phone:860-482-5384
Practice Address - Fax:860-496-4951
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003622364SX0200X, 363LA2200X
CT3622363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SX0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOncology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
06-1088532OtherTAX ID
GAQ63187Medicare UPIN
06-1088532OtherTAX ID
500002285Medicare PIN