Provider Demographics
NPI:1487247870
Name:BROWN-KIRK, JENNA NATEAL (RN)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:NATEAL
Last Name:BROWN-KIRK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3207 HACIENDA DR
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-2314
Mailing Address - Country:US
Mailing Address - Phone:707-339-0299
Mailing Address - Fax:
Practice Address - Street 1:18 E BEECH ST
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4134
Practice Address - Country:US
Practice Address - Phone:928-634-0391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-16
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ255031363LW0102X
CA95057811163WP1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WP1700XNursing Service ProvidersRegistered NursePerinatal