Individual
MRS. PAULA JEAN JENNINGS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC, LAT
Contact information
Practice address
1 UNIVERSITY AVE, FULTON, MO 65251
(573) 592-1638
Mailing address
506 CANTERBURY DR., FULTON, MO 65251
(573) 642-3581
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2002020406
MO
Other
Enumeration date
05/01/2007
Last updated
07/08/2007
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