Provider Demographics
NPI:1376971721
Name:ADAMS, JENNIFER JENAY (CNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:JENAY
Last Name:ADAMS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:JENAY
Other - Last Name:SIZEMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:825 N MAIN ST STE 120
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-2100
Mailing Address - Country:US
Mailing Address - Phone:937-762-5030
Mailing Address - Fax:937-762-5039
Practice Address - Street 1:825 N MAIN ST STE 120
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-2100
Practice Address - Country:US
Practice Address - Phone:937-762-5030
Practice Address - Fax:937-762-5039
Is Sole Proprietor?:No
Enumeration Date:2013-10-23
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.15153363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0093353Medicaid