Provider Demographics
NPI:1134257884
Name:WILCOX, JENNIFER LYNNE
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNNE
Last Name:WILCOX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 LAMBERT LN
Mailing Address - Street 2:
Mailing Address - City:WHITE MILLS
Mailing Address - State:KY
Mailing Address - Zip Code:42788-9511
Mailing Address - Country:US
Mailing Address - Phone:270-369-9455
Mailing Address - Fax:
Practice Address - Street 1:367 LAMBERT LN
Practice Address - Street 2:
Practice Address - City:WHITE MILLS
Practice Address - State:KY
Practice Address - Zip Code:42788-9511
Practice Address - Country:US
Practice Address - Phone:270-369-9455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator