Provider Demographics
NPI:1487106084
Name:MYERS, JENNY (ARNP)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1830 SE PRINCETON DR STE E
Mailing Address - Street 2:
Mailing Address - City:GRIMES
Mailing Address - State:IA
Mailing Address - Zip Code:50111-4826
Mailing Address - Country:US
Mailing Address - Phone:515-695-7195
Mailing Address - Fax:
Practice Address - Street 1:1830 SE PRINCETON DR STE E
Practice Address - Street 2:
Practice Address - City:GRIMES
Practice Address - State:IA
Practice Address - Zip Code:50111-4826
Practice Address - Country:US
Practice Address - Phone:515-695-7195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-29
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAF111388363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health