Healthcare Provider Details

I. General information

NPI: 1689474926
Provider Name (Legal Business Name): JACYNDA JO HENN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JACY HENN RN

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 03/17/2025
Certification Date: 03/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 98
PHILLIPS NE
68865-0098
US

IV. Provider business mailing address

PO BOX 98
PHILLIPS NE
68865-0098
US

V. Phone/Fax

Practice location:
  • Phone: 308-379-5763
  • Fax:
Mailing address:
  • Phone: 308-383-6520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number46600
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: