Individual provider Active NPI

Wenqiu Jennings, FNP

  • General Practice Registered Nurse
  • Marietta, GA
National Provider Identifier
1285240069
Registry record updated Sep 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice Registered NurseTaxonomy code 163WG0000X
License
RN265248 Issued in GA
Practice address
2090 Breconridge Dr SW
Marietta, GA 30064-4179
Phone
(404) 663-4715
NPI assigned
Sep 17, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 17, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Registered NurseGroup: 193400000X SINGLE SPECIALTY GROUP 163WG0000X RN265248 GA Primary

Addresses

Primary practice location

2090 Breconridge Dr SW
Marietta, GA 30064-4179

Mailing address

2090 Breconridge Dr SW
Marietta, GA 30064-4179
Phone (404) 663-4715

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211228000766 GA Practitioner - Nurse Practitioner 0042601114

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RN265248GAMDGeneral Practice Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Midnight Rose, LLC Single Specialty CurrentSince Sep 3, 2023 Accepting new patients

Locations

6380 Bells Ferry Rd
Ste 107
Acworth, GA 30102
Phone (404) 989-7384

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1600300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600300800000",
    "number": "1285240069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2090 BRECONRIDGE DR SW",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300644179",
            "telephone_number": "404-663-4715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2090 BRECONRIDGE DR SW",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300644179",
            "telephone_number": "404-663-4715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENNINGS",
        "first_name": "WENQIU",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-09-17",
        "last_updated": "2020-09-17",
        "certification_date": "2020-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WG0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse, General Practice",
            "state": "GA",
            "license": "RN265248",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

Verify at the official NPI Registry.