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General NPI Number Information
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NPI Number | 1922989649
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Entity Type | Individual
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Provider Name | JENNIFER KELLY WHITEHEAD
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Gender | Female
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Dates
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Enumeration Date | 09/09/2025
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 138 N DIXON RD
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City | KOKOMO
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State | IN
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Zip | 46901-4154
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Country | US
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Telephone | 765-236-8320
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Fax |
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Provider Business Mailing Address
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Address Line | 138 N DIXON RD
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City | KOKOMO
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State | IN
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Zip | 46901-4154
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Country | US
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Telephone | 765-236-8320
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | F08250842
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 71017312A
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License Number State | IN
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