Provider Demographics
NPI:1255349486
Name:HULETT, JENNIFER M (NP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:HULETT
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:3308 W EDGEWOOD DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-6891
Mailing Address - Country:US
Mailing Address - Phone:573-893-7848
Mailing Address - Fax:573-893-1984
Practice Address - Street 1:3308 W EDGEWOOD DR
Practice Address - Street 2:SUITE B
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-6891
Practice Address - Country:US
Practice Address - Phone:573-893-7848
Practice Address - Fax:573-893-1984
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2014-01-16
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Provider Licenses
StateLicense IDTaxonomies
MORN138219207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOS85514Medicare UPIN