Shock, Jenna L
Shock, Jenna L is an individual health care provider with primary practice located at 1690 Broadway Building 19, Suite 10, Fort Wayne IN 46802-2012. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health, Nursing Service Providers / Psychiatric/Mental Health. Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health is her primary health care specialty. Shock, Jenna L can be contacted via phone (260) 200-4940.Contact Information
Primary practice address
1690 Broadway Building 19, Suite 10
Fort Wayne IN 46802-2012
Phone: (260) 200-4940
Fax: (949) 404-6540
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health | 363LP0808X | 71009466A | Indiana |
Nursing Service Providers / Psychiatric/Mental Health | 163WP0808X | 28184986A | Indiana |
Profile Details
NPI number | 1255984738 |
---|---|
LBN Legal business name | Shock, Jenna L |
Credentials | MSN, APRN, PMHNP-BC |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | Jul 23rd, 2019 |
Last updated | May 19th, 2023 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1255984738 | NPPES |
Indiana | MEDICAID | 300031451 |
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