Provider Demographics
NPI:1568894152
Name:HENNINGTON, JANNAS ASHLEE (APN)
Entity type:Individual
Prefix:
First Name:JANNAS
Middle Name:ASHLEE
Last Name:HENNINGTON
Suffix:
Gender:
Credentials:APN
Other - Prefix:
Other - First Name:JANNAS
Other - Middle Name:ASHLEE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1090 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-3700
Mailing Address - Country:US
Mailing Address - Phone:928-583-1000
Mailing Address - Fax:
Practice Address - Street 1:51 BRIAN MICKELSEN PKWY
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-3610
Practice Address - Country:US
Practice Address - Phone:928-639-8132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ221533363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health