Healthcare Provider Details

I. General information

NPI: 1437871290
Provider Name (Legal Business Name): JENNIFER K CENTERS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39465 W 14 MILE RD
NOVI MI
48377-1600
US

IV. Provider business mailing address

1120 MARSHALL RD
TEKONSHA MI
49092-9555
US

V. Phone/Fax

Practice location:
  • Phone: 877-906-9699
  • Fax: 888-483-0118
Mailing address:
  • Phone: 877-906-9699
  • Fax: 888-483-0118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704306854
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: