Provider Demographics
NPI:1235249533
Name:HANLEY, JENNIFER A (DNP PMH/FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:A
Last Name:HANLEY
Suffix:
Gender:F
Credentials:DNP PMH/FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 DOGWOOD LNDG
Mailing Address - Street 2:
Mailing Address - City:VASS
Mailing Address - State:NC
Mailing Address - Zip Code:28394-9202
Mailing Address - Country:US
Mailing Address - Phone:910-992-8934
Mailing Address - Fax:
Practice Address - Street 1:309 DOGWOOD LNDG
Practice Address - Street 2:
Practice Address - City:VASS
Practice Address - State:NC
Practice Address - Zip Code:28394
Practice Address - Country:US
Practice Address - Phone:910-992-8934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN11884363LF0000X
TN154189363LP0808X
NCAPN1184363LF0000X
NC201498363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6113100Medicaid
NC6113100Medicaid
Q08528Medicare UPIN
NC6113100Medicaid