Provider Demographics
NPI:1164920088
Name:DE CASTRO, JENTRY ANN (DNP, FNP-C)
Entity type:Individual
Prefix:DR
First Name:JENTRY
Middle Name:ANN
Last Name:DE CASTRO
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:JENTRY
Other - Middle Name:ANN
Other - Last Name:WHEATON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 SUN TEMPLE DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-8643
Mailing Address - Country:US
Mailing Address - Phone:256-975-4291
Mailing Address - Fax:
Practice Address - Street 1:600 SUN TEMPLE DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-8643
Practice Address - Country:US
Practice Address - Phone:256-701-5651
Practice Address - Fax:256-429-9411
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-25
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS907091363LF0000X
AL1-201519363LF0000X
MT139841363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily