Provider Demographics
NPI:1972330132
Name:FET, JENNIFER RAE
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RAE
Last Name:FET
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 1:56 REGAL OAKS
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-9639
Mailing Address - Country:US
Mailing Address - Phone:304-638-3767
Mailing Address - Fax:
Practice Address - Street 1:56 REGAL OAKS
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-9639
Practice Address - Country:US
Practice Address - Phone:304-638-3767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-19
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist