Provider Demographics
NPI:1316071368
Name:JENNINGS, BERTIA A (DNP, CNP)
Entity type:Individual
Prefix:
First Name:BERTIA
Middle Name:A
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:DNP, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 BELMONT AVE STE C
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-1836
Mailing Address - Country:US
Mailing Address - Phone:330-759-0276
Mailing Address - Fax:330-759-0276
Practice Address - Street 1:8577 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-2345
Practice Address - Country:US
Practice Address - Phone:330-856-6663
Practice Address - Fax:330-856-1581
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN161405-06163W00000X
OHAPRN.CNP.05966363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2719991Medicaid
OH2719991Medicaid