Jenna Marie Mattocks, PNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

CNP 4319 Issued in MN

Practice address

610 30TH Ave W
Alexandria, MN 56308-3426

Phone

(320) 763-5123

Fax

(320) 763-5749

NPI assigned

Jan 7, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MN

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jmattocks281186@direct.centracare.com

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.

• Alomere Health

  • General Acute Care Hospital
  • Alexandria, MN
  • NPI 1558236091
  Medicare reassignment NPD
• Alexandria Clinic PA

  • Multi-Specialty Clinic/Center
  • Alexandria, MN
  • NPI 1346211315
  NPD
• Alomere Health

  • Durable Medical Equipment & Medical Supplies
  • Willmar, MN
  • NPI 1467318246
  NPD
• Douglas County Hospital

  • General Acute Care Hospital
  • Alexandria, MN
  • NPI 1164424305
  NPD
• West Central Pathology and Laboratory Medicine PA

  • Clinical Medical Laboratory
  • Alexandria, MN
  • NPI 1811988025
  NPD
• Douglas County Hospital

  • Orthopaedic Surgery Physician
  • Alexandria, MN
  • NPI 1427342138
  NPD (past)

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

{
    "created_epoch": "1452124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729468800000",
    "number": "1376909242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 30TH AVE W",
            "city": "ALEXANDRIA",
            "state": "MN",
            "postal_code": "563083426",
            "telephone_number": "320-763-5123",
            "fax_number": "320-763-5749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 30TH AVE W",
            "city": "ALEXANDRIA",
            "state": "MN",
            "postal_code": "563083426",
            "telephone_number": "320-763-5123",
            "fax_number": "320-763-5749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTOCKS",
        "first_name": "JENNA",
        "middle_name": "MARIE",
        "credential": "PNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-01-07",
        "last_updated": "2024-10-21",
        "certification_date": "2024-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MN",
            "license": "CNP 4319",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1376909242",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RN LICENSE",
            "identifier": "2074717",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CNP LICENSE",
            "identifier": "CNP 4319",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marvelles Apparel Inc
• Joseph Marvin, M.D.
• Marys Home Care LLC
• Lesha Massmann
• Cristina Mae Masten
• Megan McCormick, PT, DPT
• Erin M McCoy, P.T.
• Jerry E McCrery, MD
• Luke McFarland, DO
• Chillon A McKibbin, CNM

• Pediatric Nurse Practitioner in Alexandria, MN
• Providers in Alexandria, MN by specialty
• Pediatric Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.