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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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 3 years ago

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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1255984738 NPPES
Indiana MEDICAID 300031451

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