Provider Demographics
NPI:1609448513
Name:ROLLINS, JENNIFER LEANN
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEANN
Last Name:ROLLINS
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:PO BOX 86
Mailing Address - Street 2:
Mailing Address - City:KOPPERSTON
Mailing Address - State:WV
Mailing Address - Zip Code:24854-0086
Mailing Address - Country:US
Mailing Address - Phone:304-719-3279
Mailing Address - Fax:
Practice Address - Street 1:34 50TH STREET
Practice Address - Street 2:
Practice Address - City:KOPPERSTON
Practice Address - State:WV
Practice Address - Zip Code:24854-2485
Practice Address - Country:US
Practice Address - Phone:304-719-3279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant