Healthcare Provider Details

I. General information

NPI: 1396112496
Provider Name (Legal Business Name): JENNA WEATHERSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2015
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7130 N MILLBROOK AVE
FRESNO CA
93720-3347
US

IV. Provider business mailing address

1510 E HERNDON AVE STE 310
FRESNO CA
93720-3393
US

V. Phone/Fax

Practice location:
  • Phone: 559-326-1222
  • Fax: 559-326-1225
Mailing address:
  • Phone: 559-326-1222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95014538
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN1037919
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: