Provider Demographics
NPI:1841809696
Name:RICKENBAUGH, JENNA M (NP)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:M
Last Name:RICKENBAUGH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:M
Other - Last Name:GOGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1510
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-1510
Mailing Address - Country:US
Mailing Address - Phone:812-450-6815
Mailing Address - Fax:812-450-6822
Practice Address - Street 1:4015 GATEWAY BLVD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8925
Practice Address - Country:US
Practice Address - Phone:812-858-6244
Practice Address - Fax:812-858-6240
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28220757A363L00000X
IN71010296A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner