Provider Demographics
NPI:1720886617
Name:FENNYCH, JENNY REBECCA (LPN)
Entity type:Individual
Prefix:MS
First Name:JENNY
Middle Name:REBECCA
Last Name:FENNYCH
Suffix:
Gender:
Credentials:LPN
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:REBECCA
Other - Last Name:KOEHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5107 E EASTON ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74115-7606
Mailing Address - Country:US
Mailing Address - Phone:580-279-9036
Mailing Address - Fax:
Practice Address - Street 1:5107 E EASTON ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74115-7606
Practice Address - Country:US
Practice Address - Phone:580-279-9036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK42758164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse