Mallory Lynn Jennings, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

32226 Issued in TN

Practice address

2898 Boones Creek Rd
Johnson City, TN 37615-4975

Phone

(423) 262-0112

NPI assigned

Sep 13, 2022

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 names 1

• Ms. Mallory Lynn Kerkstra Former name

Medicare fee-for-service enrollment

Enrolled in TN

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

Specialty

Nurse Practitioner

Education

East Tennessee State University Quillen College of Medicine, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Tricities Skin and Cancer.Group PAC ID 8527031954, 15 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/21619/brand/1/csg/1/fhir/r4
• Direct secure messaging: mjennings@directaddress.net

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.

• Tricities Skin and Cancer

  • Dermatology Physician
  • Johnson City, TN
  • NPI 1295824415
  Medicare reassignment Care Compare group NPD
• East Tennessee Medical and Surgical Dermatology

  • Medical Specialty Clinic/Center
  • Johnson City, TN
  • NPI 1356975106
  NPD (past)

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

{
    "created_epoch": "1663027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663027200000",
    "number": "1447972898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3628 CREST RD",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376644014",
            "telephone_number": "423-367-1509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2898 BOONES CREEK RD",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376154975",
            "telephone_number": "423-262-0112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENNINGS",
        "first_name": "MALLORY",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-13",
        "last_updated": "2022-09-13",
        "certification_date": "2022-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "32226",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MALLORY",
            "last_name": "KERKSTRA",
            "middle_name": "LYNN",
            "prefix": "MS.",
            "credential": "RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Winona Jenkinson, PT, DPT
• Laura Beth Jenks, PHAR D
• Wesley Jenks
• Alexis Jennings
• Emily Ann Jennings, BS
• Christina M Jensen, DPT
• Jefferey Robert Jernigan, M.D.
• Perry Jernigan, M.D.
• Thomas W Jernigan, M.D.
• Bailey Scott Jessee, PA-C

• Family Nurse Practitioner in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Family Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.