Provider Demographics
NPI:1689474926
Name:HENN, JACYNDA JO (RN)
Entity type:Individual
Prefix:
First Name:JACYNDA
Middle Name:JO
Last Name:HENN
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:JACY
Other - Middle Name:
Other - Last Name:HENN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:PHILLIPS
Mailing Address - State:NE
Mailing Address - Zip Code:68865-0098
Mailing Address - Country:US
Mailing Address - Phone:308-383-6520
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 98
Practice Address - Street 2:
Practice Address - City:PHILLIPS
Practice Address - State:NE
Practice Address - Zip Code:68865-0098
Practice Address - Country:US
Practice Address - Phone:308-379-5763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE46600163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse