Provider Demographics
NPI:1447405196
Name:BILLINGSLEY, JENNIFER K (FNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:K
Last Name:BILLINGSLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:K
Other - Last Name:BOWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:29455 N CAVE CREEK RD STE 118-520
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-3245
Mailing Address - Country:US
Mailing Address - Phone:602-885-2495
Mailing Address - Fax:
Practice Address - Street 1:29455 N CAVE CREEK RD STE 118-520
Practice Address - Street 2:
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-3245
Practice Address - Country:US
Practice Address - Phone:602-885-2495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-21
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3012363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ120390OtherGROUP MEDICARE NUMBER
AZ317047OtherGROUP MEDICAID NUMBER