Healthcare Provider Details

I. General information

NPI: 1689450538
Provider Name (Legal Business Name): JESSICA RENEE ADKINS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA RENEE NELSON

II. Dates (important events)

Enumeration Date: 09/06/2023
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95-390 KUAHELANI AVE STE J-1
MILILANI HI
96789-1192
US

IV. Provider business mailing address

271 PUAKAUHI CT
HONOLULU HI
96818-5417
US

V. Phone/Fax

Practice location:
  • Phone: 808-625-6444
  • Fax:
Mailing address:
  • Phone: 304-963-3101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN-104041
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberAPRN-3499
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: