Jody Lynn Jenson, MSN,APRN,PMHNP
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Staples, MN
NPI 1669737300 · NPPES record last updated Jan 5, 2017
Key facts
- NPI
- 1669737300
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- NP-1189A (ID)
- Practice address
- 49725 County 83
Staples, MN 56479-5280 - Phone
- (218) 894-8854
- Fax
- (218) 894-8867
- NPI assigned
- Jul 9, 2012
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 1, 2023 through Jul 1, 2027
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science - Nursing, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NP-1189A | ID | MD | Psychiatric/Mental Health Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | NP-1189A | ID | Yes |
Addresses
Primary practice location
49725 County 83
Staples, MN 56479-5280
Mailing address
49725 County 83
Staples, MN 56479-5280
Phone (218) 894-8854
Other providers in Staples, MN
- Donald B Hughes
- Independent School District 2170
- Infinite Health Collaborative, PA
- Sarah Jane Israelson
- Jan Johnson
- Travis Marshall Johnson
- Barbara Kaneski I
- Brita Rose Karolus
- Olivia Kastello
- Tyler Kline
All providers in Staples, MN · Psychiatric/Mental Health Nurse Practitioner in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 5, 2017. 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.
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.