Provider Demographics
NPI:1952048373
Name:JENNINGS, DEMETRIA D (RN, BSN)
Entity Type:Individual
Prefix:
First Name:DEMETRIA
Middle Name:D
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:MRS
Other - First Name:DEMETRIA
Other - Middle Name:DAWN
Other - Last Name:JENNINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MIDKIFF
Mailing Address - Street 1:6354 US ROUTE 60 E STE 4
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-1247
Mailing Address - Country:US
Mailing Address - Phone:304-733-1626
Mailing Address - Fax:304-733-2012
Practice Address - Street 1:208 CHESHIRE WAY STE 1
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25704-2064
Practice Address - Country:US
Practice Address - Phone:304-429-0100
Practice Address - Fax:304-429-0148
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV97432163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse