Provider Demographics
NPI:1609129709
Name:JENNINGS, ABBIE (NP)
Entity Type:Individual
Prefix:
First Name:ABBIE
Middle Name:
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 912882
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80291-2882
Mailing Address - Country:US
Mailing Address - Phone:866-765-0909
Mailing Address - Fax:855-856-8520
Practice Address - Street 1:353 FAIRMONT BLVD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-7375
Practice Address - Country:US
Practice Address - Phone:605-755-8222
Practice Address - Fax:605-719-4203
Is Sole Proprietor?:No
Enumeration Date:2012-10-26
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000743363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1609129709Medicaid
SDP02096842OtherRR MEDICARE
ND1609129709Medicaid
SD1609129709OtherBCBS SD
SD1609129709Medicaid