1376729921 NPI number — JENNIFER GREGG MCINTYRE APRN-BC

Table of content: JENNIFER GREGG MCINTYRE APRN-BC (NPI 1376729921)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376729921 NPI number — JENNIFER GREGG MCINTYRE APRN-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCINTYRE
Provider First Name:
JENNIFER
Provider Middle Name:
GREGG
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376729921
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
521 S MONTGOMERY ST
Provider Second Line Business Mailing Address:
STE 1
Provider Business Mailing Address City Name:
STARKVILLE
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39759-3337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-460-4285
Provider Business Mailing Address Fax Number:
770-460-4045

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 YORKTOWN DRIVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-460-4285
Provider Business Practice Location Address Fax Number:
770-460-4045
Provider Enumeration Date:
01/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  R857047 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363L00000X , with the licence number: RN211545 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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