Healthcare Provider Details

I. General information

NPI: 1295646099
Provider Name (Legal Business Name): JENNIFER DEMKO PMHNP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 SHOVELHEAD DR
DURHAM NC
27703-2603
US

IV. Provider business mailing address

1002 SHOVELHEAD DR
DURHAM NC
27703-2603
US

V. Phone/Fax

Practice location:
  • Phone: 801-699-9130
  • Fax:
Mailing address:
  • Phone: 801-699-9130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. JENNIFER ANNE DEMKO
Title or Position: MANAGER
Credential: PMHNP-BC
Phone: 801-699-9130