Healthcare Provider Details

I. General information

NPI: 1548004179
Provider Name (Legal Business Name): JENNY KAY MARKINS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2024
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 ORTHOPAEDIC DR
WARSAW IN
46582-3994
US

IV. Provider business mailing address

700 ORTHOPAEDIC DR
WARSAW IN
46582-3994
US

V. Phone/Fax

Practice location:
  • Phone: 574-372-5937
  • Fax: 574-372-7326
Mailing address:
  • Phone: 574-372-5937
  • Fax: 574-372-7326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71015846A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number28185973A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: