Provider Demographics
NPI:1780111765
Name:KAMPS, JENNA (CPNP)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:KAMPS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2845 44TH ST SW
Mailing Address - Street 2:STE 200
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418
Mailing Address - Country:US
Mailing Address - Phone:616-538-2410
Mailing Address - Fax:616-538-1557
Practice Address - Street 1:2845 44TH ST SW
Practice Address - Street 2:STE 200
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418
Practice Address - Country:US
Practice Address - Phone:616-538-2410
Practice Address - Fax:616-538-1557
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704292171363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics