Provider Demographics
NPI:1710931548
Name:PUCKETT, JENNIFER H (MSN, ARNP, CPNP)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:H
Last Name:PUCKETT
Suffix:
Gender:F
Credentials:MSN, ARNP, CPNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:H
Other - Last Name:LESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, RN, CPNP
Mailing Address - Street 1:3355 GEORGE BUSBEE PKWY NW
Mailing Address - Street 2:APT. 1001
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-6823
Mailing Address - Country:US
Mailing Address - Phone:214-789-0423
Mailing Address - Fax:
Practice Address - Street 1:777 FRANKLIN RD SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-7803
Practice Address - Country:US
Practice Address - Phone:770-732-6007
Practice Address - Fax:770-732-8242
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX628818363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152489401Medicaid
TX01282Medicare UPIN