Jennifer Rehna Cedillo, APRN, RT(R)
Individual provider Active NPI Family Nurse Practitioner · Hinkle, KY
NPI 1548809262 · NPPES record last updated Sep 25, 2021
Key facts
- NPI
- 1548809262
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 3013765 (KY)
- Practice address
- 25 WH LN
Hinkle, KY 40953-5835 - Phone
- (606) 627-7013
- NPI assigned
- Dec 27, 2019
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 9
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200124001606 | KY | Practitioner - Nurse Practitioner | 5799110565 | Reassigns benefits to 7 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10839 | KY | MD | Body Imaging Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Concord Medical Group of Kentucky PLLC | Nurse Practitioner | Current |
Accepting new patients |
| Memorial Hospital, Inc. | Current |
Accepting new patients | |
| Southeastern Emergency Physicians LLC | Nurse Practitioner | Current |
Accepting new patients |
| Memorial Hospital Inc. | Family | Current |
Accepting new patients |
| Memorial Hospital, Inc. | Current |
Accepting new patients | |
| Memorial Hospital, Inc. | Current |
Accepting new patients | |
| Fast Pace Kentucky PLLC | Current |
Accepting new patients | |
| Memorial Hospital, Inc. | Family | Current | Accepting new patients |
| Brock Medical, LLC | Nurse Practitioner | Current |
Accepting new patients |
Locations
1700 Old Lebanon Rd
Campbellsvlle, KY 42718
Phone (270) 465-3561
1 Trillium Way
Corbin, KY 40701
Phone (606) 523-8521
1649 Highway 192 W
London, KY 40741
Phone (606) 330-0055
1033 N Highway 11
Manchester, KY 40962
Phone (606) 598-6163
210 Marie Langdon Dr
Manchester, KY 40962
Phone (865) 985-7047
239 N 12th St
Middlesboro, KY 40965
Phone (270) 632-1548
53 Queendale Ctr
Red Bird, KY 40913
Phone (606) 598-5135
1602 Avenue Q
Lubbock, TX 79401
Phone (469) 809-6712
Interoperability endpoints
- jcedillo659165@adventhealth.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Body Imaging Physician | 2085B0100X | 10839 | KY | |
| Nurse Practitioner | 363L00000X | 3013765 | KY | |
| Family Nurse Practitioner | 363LF0000X | 3013765 | KY | Yes |
Addresses
Primary practice location
25 WH LN
Hinkle, KY 40953-5835
Mailing address
25 WH LN
Hinkle, KY 40953-5835
Phone (606) 627-7013
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 25, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.