Provider Demographics
NPI:1811277668
Name:MYGATT, JENNIFER D (NP-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:D
Last Name:MYGATT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 ADAMS RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01267-2930
Mailing Address - Country:US
Mailing Address - Phone:413-458-8182
Mailing Address - Fax:413-458-3140
Practice Address - Street 1:197 ADAMS RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:MA
Practice Address - Zip Code:01267
Practice Address - Country:US
Practice Address - Phone:413-458-8182
Practice Address - Fax:413-458-3140
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT93442163WG0000X
MARN2265698163WG0000X
MA2265698363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice