Healthcare Provider Details

I. General information

NPI: 1568894152
Provider Name (Legal Business Name): JANNAS ASHLEE HENNINGTON APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JANNAS ASHLEE JOHNSON APRN

II. Dates (important events)

Enumeration Date: 08/06/2013
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 STETSON RD UNIT 310
PRESCOTT AZ
86303-3361
US

IV. Provider business mailing address

1206 STETSON RD UNIT 310
PRESCOTT AZ
86303-3361
US

V. Phone/Fax

Practice location:
  • Phone: 928-766-4708
  • Fax: 928-837-3118
Mailing address:
  • Phone: 928-766-4708
  • Fax: 928-837-3118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number221533
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: