Healthcare Provider Details

I. General information

NPI: 1336065382
Provider Name (Legal Business Name): JESSICA LYNN HENN MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2691 LESLIE RD
MOUNT AIRY MD
21771-8821
US

IV. Provider business mailing address

2691 LESLIE RD
MOUNT AIRY MD
21771-8821
US

V. Phone/Fax

Practice location:
  • Phone: 410-948-3224
  • Fax:
Mailing address:
  • Phone: 410-948-3224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF05260275
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: