Individual provider Active NPI

Kaila Jenaman, APRN

  • Psychiatric/Mental Health Nurse Practitioner
  • Moline, IL
National Provider Identifier
1699305136
Registry record updated Jan 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
209020362 Issued in IL
Practice address
4600 3Rd St
Moline, IL 61265-6106
Phone
(309) 779-2013
NPI assigned
Jan 23, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X G156992 IA
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 209020362 IL Primary

Addresses

Primary practice location

4600 3Rd St
Moline, IL 61265-6106

Mailing address

19 Hidden Valley Cir
Davenport, IA 52804-1159
Phone (563) 349-1245

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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
I20220920001376 IA Practitioner - Nurse Practitioner 9638509763 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Rush Medical College of Rush University, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Genesis Health SystemGroup PAC ID 6103829338, 262 clinicians

Practice addresses (Care Compare)

1401 W Central Park Ave
Mercyone Genesis
Davenport, IA 52804-1707
Phone (563) 421-1000

Hospital & facility affiliations

  • Genesis Medical Center-Davenport Hospital, Davenport, IA, CCN 160033

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
G156992IAMDPsychiatric/Mental Health Nurse Practitioner
209020362ILMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St Luke'S Methodist Hospital Current Accepting new patients
Genesis Health System CurrentSince Jan 6, 2025 Accepting new patients
Genesis Health System CurrentSince Jan 6, 2025 Accepting new patients

Locations

865 Lincoln Rd
Ste 100
Bettendorf, IA 52722
Phone (563) 355-1000

1351 W Central Park Ave
Ste 4100
Davenport, IA 52804
Phone (563) 355-9191

4700 E 56th St
Ste 100
Davenport, IA 52807
Phone (563) 383-2667

1401 W Central Park Ave
Davenport, IA 52804
Phone (563) 421-1900

Interoperability endpoints

  • Direct secure messaging: kjenaman128060@direct.unitypoint.org

Organizations & group practices 3

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1579737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579737600000",
    "number": "1699305136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 HIDDEN VALLEY CIR",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528041159",
            "telephone_number": "563-349-1245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4600 3RD ST",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612656106",
            "telephone_number": "309-779-2013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENAMAN",
        "first_name": "KAILA",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-23",
        "last_updated": "2020-01-23",
        "certification_date": "2020-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IA",
            "license": "G156992",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "209020362",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moline, IL

Sources for this page

Verify at the official NPI Registry.