Provider Demographics
NPI:1386459907
Name:BUETTEMEYER, JENNA K (RN BSN)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:K
Last Name:BUETTEMEYER
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10024 BUNCH CIR
Mailing Address - Street 2:
Mailing Address - City:GRAVETTE
Mailing Address - State:AR
Mailing Address - Zip Code:72736-8532
Mailing Address - Country:US
Mailing Address - Phone:479-795-9322
Mailing Address - Fax:
Practice Address - Street 1:351 W CENTERTON BLVD
Practice Address - Street 2:
Practice Address - City:CENTERTON
Practice Address - State:AR
Practice Address - Zip Code:72719-9218
Practice Address - Country:US
Practice Address - Phone:479-310-8294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR084597163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool