Basic Information
| Provider Information | |||||||||
| NPI: | 1760848410 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VARGAS | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | COVIE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1870 BAGNELL DAM BLVD | ||||||||
| Address2: | |||||||||
| City: | LAKE OZARK | ||||||||
| State: | MO | ||||||||
| PostalCode: | 650498658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5733652318 | ||||||||
| FaxNumber: | 5733653009 | ||||||||
| Practice Location | |||||||||
| Address1: | 1870 BAGNELL DAM BLVD | ||||||||
| Address2: | |||||||||
| City: | LAKE OZARK | ||||||||
| State: | MO | ||||||||
| PostalCode: | 650498658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5733652318 | ||||||||
| FaxNumber: | 5733653009 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2016 | ||||||||
| LastUpdateDate: | 04/24/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 2016000429 | MO | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | A006120 | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.