Provider Demographics
NPI:1801013081
Name:KENNA, JAYMA M (RN)
Entity Type:Individual
Prefix:
First Name:JAYMA
Middle Name:M
Last Name:KENNA
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 1:351 NEW SHACKLE ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-2300
Mailing Address - Country:US
Mailing Address - Phone:615-824-0552
Mailing Address - Fax:615-824-9771
Practice Address - Street 1:351 NEW SHACKLE ISLAND RD
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2300
Practice Address - Country:US
Practice Address - Phone:615-824-0552
Practice Address - Fax:615-824-9771
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN142702163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN142702OtherRN