Healthcare Provider Details

I. General information

NPI: 1124666284
Provider Name (Legal Business Name): DENA RENEE' JENKINS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2019
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E 14TH ST
SEDALIA MO
65301-5972
US

IV. Provider business mailing address

601 E 14TH ST
SEDALIA MO
65301-5972
US

V. Phone/Fax

Practice location:
  • Phone: 660-826-1482
  • Fax:
Mailing address:
  • Phone: 660-826-1482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2019047369
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: