Provider Demographics
NPI:1841009537
Name:WHITEHEAD, JENSYN SERENE (FNP-C)
Entity type:Individual
Prefix:
First Name:JENSYN
Middle Name:SERENE
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 TOWNSHIP ROAD 209
Mailing Address - Street 2:
Mailing Address - City:WILLOW WOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45696-9041
Mailing Address - Country:US
Mailing Address - Phone:740-646-8563
Mailing Address - Fax:
Practice Address - Street 1:404 FERRY ST
Practice Address - Street 2:
Practice Address - City:RUSSELL
Practice Address - State:KY
Practice Address - Zip Code:41169-1343
Practice Address - Country:US
Practice Address - Phone:606-388-2399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY403370363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner