Provider Demographics
NPI:1326650789
Name:PUTNAM-SCOTT, JENNIFER R (MSN, AGNP-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:PUTNAM-SCOTT
Suffix:
Gender:
Credentials:MSN, AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 505351
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-5351
Mailing Address - Country:US
Mailing Address - Phone:731-660-8730
Mailing Address - Fax:731-660-8739
Practice Address - Street 1:569 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3911
Practice Address - Country:US
Practice Address - Phone:731-664-7395
Practice Address - Fax:731-660-8739
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNINPROCESS363L00000X
TN28168363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner