Provider Demographics
NPI:1013979483
Name:GLOCKNER, JENNIFER KNAPP (APRN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KNAPP
Last Name:GLOCKNER
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:PO BOX 1595
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-1595
Mailing Address - Country:US
Mailing Address - Phone:606-408-6200
Mailing Address - Fax:606-408-6612
Practice Address - Street 1:8750 OHIO RIVER RD
Practice Address - Street 2:
Practice Address - City:WHEELERSBURG
Practice Address - State:OH
Practice Address - Zip Code:45694-1918
Practice Address - Country:US
Practice Address - Phone:740-574-9301
Practice Address - Fax:740-574-1651
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3005602363LF0000X
OH08395-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100048540Medicaid
OHP00752624OtherRR MEDICARE
OH2848459Medicaid
OH2848459Medicaid
OHNP22965Medicare PIN
KY3403682Medicare PIN