MEDICARE: SHARONDA JENNINGS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	228349	TN

General Provider Information

NPI Number	:	1689513855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARONDA JENNINGS

Provider Business Mailing Address
First Line	:	3884 KIPLING AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38128-2120
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3884 KIPLING AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38128-2120
Country	:	US
Telephone Number	:	901-649-1138
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2026
Last Update Date	:	03/25/2026

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Directions to “ SHARONDA JENNINGS ” Practice Location

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