Basic Information
Provider Information | |||||||||
NPI: | 1184068108 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HOVEST | ||||||||
FirstName: | JENNIFER | ||||||||
MiddleName: | F | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | CNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 24 HARVESTER DR | ||||||||
Address2: |   | ||||||||
City: | COPLEY | ||||||||
State: | OH | ||||||||
PostalCode: | 443211003 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4192611770 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 5001 ROCKSIDE RD | ||||||||
Address2: | CROWNE PLAZA II | ||||||||
City: | INDEPENDENCE | ||||||||
State: | OH | ||||||||
PostalCode: | 441312172 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2169864000 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/21/2013 | ||||||||
LastUpdateDate: | 03/29/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN.361253 | OH | N |   | Nursing Service Providers | Registered Nurse |   | 363LP0200X | COA.14745-NP | OH | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | 363LF0000X | COA.14745-NP | OH | N |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
ID | Type | State | Issuer | Description | 0094973 | 05 | OH |   | MEDICAID |