Jenny Lee Mahoney, IDC

Primary specialty

Independent Duty CorpsmanTaxonomy code 1710I1002X

Practice address

55281 Yellow Jacket Dr
Callahan, FL 32011-8534

Phone

(757) 672-8533

NPI assigned

Jul 18, 2019

Sex

Female

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 7, 2020.

{
    "created_epoch": "1563408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578355200000",
    "number": "1043863079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55281 YELLOW JACKET DR",
            "city": "CALLAHAN",
            "state": "FL",
            "postal_code": "320118534",
            "telephone_number": "757-672-8533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55281 YELLOW JACKET DR",
            "city": "CALLAHAN",
            "state": "FL",
            "postal_code": "320118534",
            "telephone_number": "757-672-8533"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2480 Bon Hommes Richard St",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "32227",
            "country_code": "US",
            "telephone_number": "904-542-2338",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAHONEY",
        "first_name": "JENNY",
        "middle_name": "LEE",
        "credential": "IDC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-07-18",
        "last_updated": "2020-01-07",
        "certification_date": "2020-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1002X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brett J Lawson
• LBJ Transportation
• Christine M Lefko, DPT
• Danelys Leyva Chacon, DMD
• Elizabeth Ann Luke, DOULA
• Bayley Marsh, DPT
• Margaret Nancy Martini, FNP-C
• Leroy John Mathew
• Douglas Michael Matthews, RN 9342045
• Stephanie Ann May, APRN

• All providers in Callahan, FL
• Independent Duty Corpsman in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2020; 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.