Provider Demographics
NPI:1972928034
Name:MARKS, JENNIFER JOE-ANNE (PMHNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JOE-ANNE
Last Name:MARKS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 OAK ST. STE #205
Mailing Address - Street 2:
Mailing Address - City:CENTRAL POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97502
Mailing Address - Country:US
Mailing Address - Phone:541-299-0390
Mailing Address - Fax:541-299-0562
Practice Address - Street 1:312 OAK ST. STE #205
Practice Address - Street 2:
Practice Address - City:CENTRAL POINT
Practice Address - State:OR
Practice Address - Zip Code:97502
Practice Address - Country:US
Practice Address - Phone:541-299-0390
Practice Address - Fax:541-299-0562
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-26
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201401611NP-PP163WP0807X, 363LP0808X
OR200741772RN163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent