Provider Demographics
NPI:1669426466
Name:EATON, JENNIFER (ATC/L)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:EATON
Suffix:
Gender:F
Credentials:ATC/L
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:BLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC/L
Mailing Address - Street 1:RR 1 BOX 270
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:MO
Mailing Address - Zip Code:64772-9743
Mailing Address - Country:US
Mailing Address - Phone:417-448-8914
Mailing Address - Fax:
Practice Address - Street 1:800 S ASH ST
Practice Address - Street 2:NEVADA REGIONAL MEDICAL CENTER
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772-3223
Practice Address - Country:US
Practice Address - Phone:417-448-3790
Practice Address - Fax:417-448-3654
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer