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General NPI Number Information
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NPI Number | 1841009537
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Entity Type | Individual
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Provider Name | JENSYN SERENE WHITEHEAD FNP-C
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Gender | Female
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Dates
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Enumeration Date | 01/06/2025
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 404 FERRY ST
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City | RUSSELL
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State | KY
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Zip | 41169-1343
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Country | US
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Telephone | 606-388-2399
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Fax |
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Provider Business Mailing Address
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Address Line | 111 TOWNSHIP ROAD 209
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City | WILLOW WOOD
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State | OH
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Zip | 45696-9041
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Country | US
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Telephone | 740-646-8563
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 403370
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License Number State | KY
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