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NPI Code Detail

MEDICARE: MRS. JENNIFER HAWKINS PENTECOST APRN, FNP-C, CLC

MEDICARE: MRS. JENNIFER HAWKINS PENTECOST APRN, FNP-C, CLC
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
1163W00000XRegistered Nurse1112785KY
2176B00000XMidwife4048665KY
3363L00000XNurse Practitioner3012362KY
4367A00000XAdvanced Practice Midwife4048665KY
5363LF0000XFamily Nurse Practitioner3012362KY
6363LF0000XFamily Nurse Practitioner4048665KY

General Provider Information

NPI Number : 1881102739
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JENNIFER HAWKINS PENTECOST APRN, FNP-C, CLC
Provider Business Mailing Address
First Line : PO BOX 776351
Second Line :
City : CHICAGO
State : IL
Zip : 60677-6351
Country : US
Telephone Number : 502-559-9425
Fax Number : 502-272-5339
Provider Business Practice Location Address
First Line : 4001 DUTCHMANS LN
Second Line :
City : LOUISVILLE
State : KY
Zip : 40207-4714
Country : US
Telephone Number : 502-893-1270
Fax Number : 502-894-1321
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2018
Last Update Date : 12/04/2025

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