Healthcare Provider Details

I. General information

NPI: 1871417121
Provider Name (Legal Business Name): KRISTA SHEA JENNINGS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

984 STANISLAUS WAY
SANTA ROSA CA
95401-7811
US

IV. Provider business mailing address

984 STANISLAUS WAY
SANTA ROSA CA
95401-7811
US

V. Phone/Fax

Practice location:
  • Phone: 707-529-6815
  • Fax:
Mailing address:
  • Phone: 707-529-6815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number0073026
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: