Healthcare Provider Details

I. General information

NPI: 1689513855
Provider Name (Legal Business Name): SHARONDA JENNINGS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3884 KIPLING AVE
MEMPHIS TN
38128-2120
US

IV. Provider business mailing address

3884 KIPLING AVE
MEMPHIS TN
38128-2120
US

V. Phone/Fax

Practice location:
  • Phone: 901-649-1138
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number228349
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: