Healthcare Provider Details

I. General information

NPI: 1811481542
Provider Name (Legal Business Name): MELISSA LOUISE JENNINGS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELISSA LOUISE RAY

II. Dates (important events)

Enumeration Date: 06/16/2018
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 34TH ST STE 100
BAKERSFIELD CA
93301-2307
US

IV. Provider business mailing address

625 34TH ST STE 100
BAKERSFIELD CA
93301-2307
US

V. Phone/Fax

Practice location:
  • Phone: 833-678-2781
  • Fax:
Mailing address:
  • Phone: 833-678-2781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP95009380
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number825774
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberNP95009380
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: