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NPI Code Detail

MEDICARE: MS. MARY PAMELA JENNINGS CRNP, FNP/GNP-BC

MEDICARE: MS. MARY PAMELA JENNINGS CRNP, FNP/GNP-BC
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
1363LF0000XFamily Nurse PractitionerTPAN2027FL
2363LF0000XFamily Nurse Practitioner1-080489AL

General Provider Information

NPI Number : 1891779294
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARY PAMELA JENNINGS CRNP, FNP/GNP-BC
Provider Business Mailing Address
First Line : PO BOX 211699
Second Line :
City : EAGAN
State : MN
Zip : 55121-3699
Country : US
Telephone Number : 866-849-0692
Fax Number : 888-973-8821
Provider Business Practice Location Address
First Line : 1 PERIMETER PARK S STE 195A
Second Line :
City : BIRMINGHAM
State : AL
Zip : 35243-2327
Country : US
Telephone Number : 866-849-0692
Fax Number : 888-973-8821
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2005
Last Update Date : 01/09/2024

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