Healthcare Provider Details

I. General information

NPI: 1114209988
Provider Name (Legal Business Name): JENNA LOUISE CHAMBLESS PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2011
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6332 GABRIELA TRL
KALAMAZOO MI
49009-6518
US

IV. Provider business mailing address

6332 GABRIELA TRL
KALAMAZOO MI
49009-6518
US

V. Phone/Fax

Practice location:
  • Phone: 734-673-6460
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704266094
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704266094
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number4704266094
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: