Provider Demographics
NPI:1760716633
Name:STUCKEY, JENNIFER T (RN,MSN,CNM)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:T
Last Name:STUCKEY
Suffix:
Gender:F
Credentials:RN,MSN,CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:682 HEMLOCK ST
Mailing Address - Street 2:STE 210
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-8314
Mailing Address - Country:US
Mailing Address - Phone:478-742-6738
Mailing Address - Fax:478-742-6153
Practice Address - Street 1:682 HEMLOCK ST
Practice Address - Street 2:STE 210
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-8314
Practice Address - Country:US
Practice Address - Phone:478-742-6738
Practice Address - Fax:478-742-6153
Is Sole Proprietor?:No
Enumeration Date:2009-09-25
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN148291367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife