Provider Demographics
NPI:1841912557
Name:HAUPERT, JENNA ROSE MCDONALD (APRN, DNP, AG-ACNP)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:ROSE MCDONALD
Last Name:HAUPERT
Suffix:
Gender:F
Credentials:APRN, DNP, AG-ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3428 OAKBROOK DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-1396
Mailing Address - Country:US
Mailing Address - Phone:859-608-8543
Mailing Address - Fax:
Practice Address - Street 1:800 ROSE ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-3008
Practice Address - Country:US
Practice Address - Phone:859-323-9057
Practice Address - Fax:859-323-9502
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPENDING363LC0200X
KY3018540363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine