Provider Demographics
NPI:1508318767
Name:GINDT, JENNIFER L (ARNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:GINDT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 LAKESIDE CT
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-7305
Mailing Address - Country:US
Mailing Address - Phone:194-947-0277
Mailing Address - Fax:
Practice Address - Street 1:1410 LAKESIDE CT
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-7305
Practice Address - Country:US
Practice Address - Phone:194-947-0277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60702213363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2073555Medicaid