Provider Demographics
NPI:1215728183
Name:JENNINGS, JOHN B
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:B
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4841 GOLDENROD LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68512-1323
Mailing Address - Country:US
Mailing Address - Phone:402-570-5911
Mailing Address - Fax:
Practice Address - Street 1:4841 GOLDENROD LN
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-1323
Practice Address - Country:US
Practice Address - Phone:402-570-5911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide