Provider Demographics
NPI:1417253550
Name:KEMP, JEANNINE (NP)
Entity type:Individual
Prefix:
First Name:JEANNINE
Middle Name:
Last Name:KEMP
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E DAILY DR STE 228
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-5840
Mailing Address - Country:US
Mailing Address - Phone:805-914-0637
Mailing Address - Fax:805-693-4327
Practice Address - Street 1:601 E DAILY DR STE 228
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-5840
Practice Address - Country:US
Practice Address - Phone:805-914-0637
Practice Address - Fax:805-693-4327
Is Sole Proprietor?:No
Enumeration Date:2011-02-08
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003911363LA2200X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NO10153900OtherLICENSE