Provider Demographics
NPI:1417607755
Name:HULL, JENNA RAE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:RAE
Last Name:HULL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:RAE
Other - Last Name:RIDENHOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7301 ROGERS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-4100
Mailing Address - Country:US
Mailing Address - Phone:479-314-6241
Mailing Address - Fax:479-452-0275
Practice Address - Street 1:7301 ROGERS AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4100
Practice Address - Country:US
Practice Address - Phone:479-314-6241
Practice Address - Fax:479-452-0275
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-28
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR219068363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily