Healthcare Provider Details

I. General information

NPI: 1154006997
Provider Name (Legal Business Name): JENNA JENKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4033 RHODES AVE
PORTSMOUTH OH
45662-5556
US

IV. Provider business mailing address

506 JEANNINE ST
IRONTON OH
45638-1110
US

V. Phone/Fax

Practice location:
  • Phone: 740-529-1201
  • Fax: 740-529-0861
Mailing address:
  • Phone: 740-534-2216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0041609
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN.521049
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: