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Individual
JESSIE ELIZABETH KONYNENBELT
Active
Individual
JESSIE ELIZABETH KONYNENBELT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3241
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019091800
—
FL
01
—
OPC5273
STATE LICENSE
FL
Enumeration date
09/10/2015
Last updated
09/19/2023
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