Provider Demographics
NPI:1821286972
Name:PUCKETT, JENNIFER (RN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:PUCKETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5715 US HIGHWAY 22 E
Mailing Address - Street 2:
Mailing Address - City:NEW HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43145-9616
Mailing Address - Country:US
Mailing Address - Phone:740-572-1206
Mailing Address - Fax:
Practice Address - Street 1:5715 US HIGHWAY 22 E
Practice Address - Street 2:
Practice Address - City:NEW HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43145-9616
Practice Address - Country:US
Practice Address - Phone:740-572-1206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.295068163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse