Provider Demographics
NPI:1891779294
Name:JENNINGS, MARY PAMELA (CRNP, FNP/GNP-BC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:PAMELA
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:CRNP, FNP/GNP-BC
Other - Prefix:MS
Other - First Name:MARY PAMELA
Other - Middle Name:MILLAN
Other - Last Name:JENNINGS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP, FNP/GNP-BC
Mailing Address - Street 1:PO BOX 211699
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-3699
Mailing Address - Country:US
Mailing Address - Phone:866-849-0692
Mailing Address - Fax:888-973-8821
Practice Address - Street 1:1 PERIMETER PARK S STE 195A
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-2327
Practice Address - Country:US
Practice Address - Phone:866-849-0692
Practice Address - Fax:888-973-8821
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTPAN2027363LF0000X
AL1-080489363LF0000X, 363LG0600X
ARA02958363LF0000X
AK1034363LF0000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51532067OtherBCBS OF AL
AL51520604OtherBCBS ALABAMA
AL51531721OtherBCBS OF AL
AL51520604OtherBCBS ALABAMA