Provider Demographics
NPI:1720203060
Name:AHMED, JENNY (APNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:
Last Name:AHMED
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 MAXWELL AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47711-4359
Mailing Address - Country:US
Mailing Address - Phone:812-422-7974
Mailing Address - Fax:812-671-0627
Practice Address - Street 1:2015 MAXWELL AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47711-4359
Practice Address - Country:US
Practice Address - Phone:812-422-7974
Practice Address - Fax:812-422-8163
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2841-033363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIP00776423Medicare Oscar/Certification
WI000091Medicare Oscar/Certification