Healthcare Provider Details

I. General information

NPI: 1578867016
Provider Name (Legal Business Name): DONNA K JENNINGS A.P.R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/24/2010
Last Update Date: 03/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 CEDAR ST
MISSOULA MT
59802
US

IV. Provider business mailing address

1120 CEDAR ST
MISSOULA MT
59802-3911
US

V. Phone/Fax

Practice location:
  • Phone: 406-543-1929
  • Fax:
Mailing address:
  • Phone: 406-543-1929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License Number8886
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number8886
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number8886
License Number StateMT
# 4
Primary TaxonomyN
Taxonomy Code364SP0810X
TaxonomyChild & Family Psychiatric/Mental Health Clinical Nurse Specialist
License Number8886
License Number StateMT
# 5
Primary TaxonomyN
Taxonomy Code364SP0811X
TaxonomyChronically Ill Psychiatric/Mental Health Clinical Nurse Specialist
License Number8886
License Number StateMT
# 6
Primary TaxonomyN
Taxonomy Code364SP0812X
TaxonomyCommunity Psychiatric/Mental Health Clinical Nurse Specialist
License Number8886
License Number StateMT
# 7
Primary TaxonomyN
Taxonomy Code364SP0813X
TaxonomyGeropsychiatric Psychiatric/Mental Health Clinical Nurse Specialist
License Number8886
License Number StateMT
# 8
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number8886
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: