Provider Demographics
NPI:1699743476
Name:JENNINGS, DENISE K (FNP)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:K
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 VICTORY LANE
Mailing Address - Street 2:
Mailing Address - City:CAINSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64632-0136
Mailing Address - Country:US
Mailing Address - Phone:660-893-5750
Mailing Address - Fax:660-893-5751
Practice Address - Street 1:707 VICTORY LANE
Practice Address - Street 2:
Practice Address - City:CAINSVILLE
Practice Address - State:MO
Practice Address - Zip Code:64632-0136
Practice Address - Country:US
Practice Address - Phone:660-893-5750
Practice Address - Fax:660-893-5751
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO102062363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO428904700Medicaid
S58156Medicare UPIN
1458277HMedicare ID - Type Unspecified
MO428904700Medicaid