Provider Demographics
NPI:1548809262
Name:CEDILLO, JENNIFER REHNA (APRN, RT(R))
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:REHNA
Last Name:CEDILLO
Suffix:
Gender:F
Credentials:APRN, RT(R)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 WH LN
Mailing Address - Street 2:
Mailing Address - City:HINKLE
Mailing Address - State:KY
Mailing Address - Zip Code:40953-5835
Mailing Address - Country:US
Mailing Address - Phone:606-627-7013
Mailing Address - Fax:
Practice Address - Street 1:25 WH LN
Practice Address - Street 2:
Practice Address - City:HINKLE
Practice Address - State:KY
Practice Address - Zip Code:40953-5835
Practice Address - Country:US
Practice Address - Phone:606-627-7013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-27
Last Update Date:2021-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY108392085B0100X
KY3013765363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner