MEDICARE: JANNAS ASHLEE HENNINGTON APN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	221533	AZ

General Provider Information

NPI Number	:	1568894152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANNAS ASHLEE HENNINGTON APN

Provider Business Mailing Address
First Line	:	1090 COMMERCE DR
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86305-3700
Country	:	US
Telephone Number	:	928-583-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	51 BRIAN MICKELSEN PKWY
Second Line	:
City	:	COTTONWOOD
State	:	AZ
Zip	:	86326-3610
Country	:	US
Telephone Number	:	928-639-8132
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2013
Last Update Date	:	04/14/2025

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