Provider Demographics
NPI:1417713249
Name:KEPHART, JENNA MARIE (RN)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:MARIE
Last Name:KEPHART
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 EISENHOWER BLVD
Mailing Address - Street 2:318 STUDENT HEALTH CENTER
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:16802
Mailing Address - Country:US
Mailing Address - Phone:814-863-8448
Mailing Address - Fax:
Practice Address - Street 1:1 EISENHOWER BLVD
Practice Address - Street 2:318 STUDENT HEALTH CENTER
Practice Address - City:UNIVERSITY PARK
Practice Address - State:PA
Practice Address - Zip Code:16802
Practice Address - Country:US
Practice Address - Phone:814-863-8448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN331488L163WC1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1400XNursing Service ProvidersRegistered NurseCollege Health