Provider Demographics
NPI:1366487951
Name:WINNINGHAM, JENNIFER MARIE (MS, ATC, LAT)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:MARIE
Last Name:WINNINGHAM
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 WESTGATE CIR
Mailing Address - Street 2:APT B
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506-5484
Mailing Address - Country:US
Mailing Address - Phone:931-260-8173
Mailing Address - Fax:
Practice Address - Street 1:TENNESSEE TECH UNIVERSITY SPORTS MEDICINE
Practice Address - Street 2:1600 PEACHTREE AVE
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38505-0001
Practice Address - Country:US
Practice Address - Phone:931-372-3934
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000010012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer