Provider Demographics
NPI:1801228317
Name:VERTREES, JENNIFER L (APRN)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:L
Last Name:VERTREES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11969 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:KY
Mailing Address - Zip Code:42776-9739
Mailing Address - Country:US
Mailing Address - Phone:270-369-9706
Mailing Address - Fax:270-706-1914
Practice Address - Street 1:11969 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:KY
Practice Address - Zip Code:42776-9739
Practice Address - Country:US
Practice Address - Phone:270-369-9706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008105363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64315781Medicaid
207R00000XOtherTAXONOMY
KY64315781Medicaid