Healthcare Provider Details

I. General information

NPI: 1881102739
Provider Name (Legal Business Name): JENNIFER HAWKINS PENTECOST APRN, FNP-C, CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER PENTECOST CNM

II. Dates (important events)

Enumeration Date: 01/12/2018
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 DUTCHMANS LN
LOUISVILLE KY
40207-4714
US

IV. Provider business mailing address

PO BOX 776351
CHICAGO IL
60677-6351
US

V. Phone/Fax

Practice location:
  • Phone: 502-893-1270
  • Fax: 502-894-1321
Mailing address:
  • Phone: 502-975-2213
  • Fax: 502-272-5339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3012362
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3012362
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4048665
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number3012362
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1112785
License Number StateKY
# 6
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number4048665
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: