JENNA MARIE MATTOCKS PNP NPI 1376909242

NPI Information

NPI: 1376909242
Provider Name: JENNA MARIE MATTOCKS, PNP
Classification: Nurse Practitioner - 363LP0200X
Entity Type: Individual

Specialization: Pediatrics

PECOS Registration: Yes

Address:
610 30TH AVE W
ALEXANDRIA, MN
ZIP 56308
Phone: (320) 763-5123
Get Directions

Jenna Marie Mattocks, PNP is a pediatrics nurse practitioner in Alexandria, MN. Jenna Marie Mattocks, PNP NPI is 1376909242. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

610 30TH AVE W
ALEXANDRIA, MN
ZIP 56308-426
Phone: (320) 763-5123
Fax: (320) 763-5749

The NPI 1376909242 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 1/7/2016 and was last updated on 3/7/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LP0200X	Nurse Practitioner	Pediatrics	CNP 4319	MINNESOTA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	CNP 4319	OTHER	MINNESOTA	CNP LICENSE
2	2074717	OTHER	MINNESOTA	RN LICENSE
3	1376909242	OTHER	MINNESOTA	NPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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