Provider Demographics
NPI:1598363731
Name:STOVER, JENNY BRYANT
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:BRYANT
Last Name:STOVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 BARANOF W
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-6207
Mailing Address - Country:US
Mailing Address - Phone:614-530-1195
Mailing Address - Fax:
Practice Address - Street 1:158 BARANOF W
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-6207
Practice Address - Country:US
Practice Address - Phone:614-530-1195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-10
Last Update Date:2020-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2568163Medicaid