Jenna Walck

Primary specialty

Critical Care Neonatal Nurse PractitionerTaxonomy code 363LN0005X

License

20795 Issued in TN

Practice address

130 S Bryn Mawr Ave
Bryn Mawr, PA 19010-3143

Phone

(484) 337-3000

NPI assigned

Dec 26, 2015

Last updated

Jul 19, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1451088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531958400000",
    "number": "1023473659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4111 IDAHO AVE",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372093678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 S BRYN MAWR AVE",
            "city": "BRYN MAWR",
            "state": "PA",
            "postal_code": "190103143",
            "telephone_number": "484-337-3000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "255 W Lancaster Ave",
            "address_purpose": "LOCATION",
            "city": "Paoli",
            "state": "PA",
            "postal_code": "193011793",
            "country_code": "US",
            "telephone_number": "484-565-1000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 E Lancaster Ave",
            "address_purpose": "LOCATION",
            "city": "Wynnewood",
            "state": "PA",
            "postal_code": "190963450",
            "country_code": "US",
            "telephone_number": "484-476-2000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2200 Childrens Way",
            "address_purpose": "LOCATION",
            "city": "Nashville",
            "state": "TN",
            "postal_code": "372320001",
            "country_code": "US",
            "telephone_number": "615-936-1000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1068 W Baltimore Pike",
            "address_purpose": "LOCATION",
            "city": "Media",
            "state": "PA",
            "postal_code": "190635177",
            "country_code": "US",
            "telephone_number": "610-891-5104",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALCK",
        "first_name": "JENNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-12-26",
        "last_updated": "2018-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LN0005X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal, Critical Care",
            "state": "TN",
            "license": "20795",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christine Wachter, MS, LPC
• Alexandra M Wack, CRNP
• Daniel S. Wagman, PAC
• Kristin Behrens Wagner, M.A.
• Stephen David Wakulchik Jr., MD
• Michael James Walker, MD
• Hilary P Waller, LPC
• Alexis Marie Walls, PA-C
• Kevin Michael Walsh, M.D.
• Sandra Lee Walsh, PSY.D.

• Critical Care Neonatal Nurse Practitioner in Bryn Mawr, PA
• Providers in Bryn Mawr, PA by specialty
• Critical Care Neonatal Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.