Provider Demographics
NPI:1760680235
Name:KEMP, JENNA (MD)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:KEMP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 E HICKMAN RD
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-5011
Mailing Address - Country:US
Mailing Address - Phone:515-987-3447
Mailing Address - Fax:515-987-6957
Practice Address - Street 1:30 E HICKMAN RD
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-5011
Practice Address - Country:US
Practice Address - Phone:515-987-3447
Practice Address - Fax:515-987-6957
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR8059207Q00000X
IA37889207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1760680235Medicaid
IA1760680235Medicaid
IA719260122Medicare PIN