Provider Demographics
NPI:1295005213
Name:HENRY, JENNIFER M (CHP-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:HENRY
Suffix:
Gender:F
Credentials:CHP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 189
Mailing Address - Street 2:
Mailing Address - City:UNALAKLEET
Mailing Address - State:AK
Mailing Address - Zip Code:99684
Mailing Address - Country:US
Mailing Address - Phone:907-923-3311
Mailing Address - Fax:907-923-2287
Practice Address - Street 1:AIRPORT ROAD 189
Practice Address - Street 2:
Practice Address - City:UNALAKLEET
Practice Address - State:AK
Practice Address - Zip Code:99684
Practice Address - Country:US
Practice Address - Phone:907-624-3535
Practice Address - Fax:907-624-3692
Is Sole Proprietor?:No
Enumeration Date:2012-01-06
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK07-924-IV172V00000X
AK07-927-P172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK07-924-IVOtherCHA IV