| NPI | 1245853498 |
|---|---|
| Former Name | JENNIFER LYNN FORAKER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: KY 3014515) |
| Enumeration Date | 2020-05-22 |
| Last Update Date | 2020-12-01 |