Mrs Jenell Diane Jackley, CPNP in Kenosha, WI

Mrs Jenell Diane Jackley, CPNP is a medicare enrolled "Nurse Practitioner - Pediatrics" in Kenosha, Wisconsin. Her current practice location is 4006 Washington Rd, Kenosha, Wisconsin. You can reach out to her office (for appointments etc.) via phone at (262) 656-0044.

Mrs Jenell Diane Jackley is licensed to practice in Wisconsin (license number 12260-33) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1942502612.

Contact Information

	Mrs Jenell Diane Jackley, CPNP
	4006 Washington Rd, Kenosha, WI 53144-4819
	(262) 656-0044
	Not Available

Map and Direction

Provider's Profile

Full Name	Mrs Jenell Diane Jackley
Gender	Female
Speciality	Nurse Practitioner - Pediatrics
Location	4006 Washington Rd, Kenosha, Wisconsin
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1942502612
Provider Enumeration Date: 11/30/2010
Last Update Date: 09/07/2023

Medicare PECOS Information:

PECOS PAC ID: 3577929009
Enrollment ID: I20230525001181

Medical Identifiers

Medical identifiers for Mrs Jenell Diane Jackley such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1942502612	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
163W00000X	Registered Nurse	041.389592 (Illinois)	Secondary
163W00000X	Registered Nurse	163094-030 (Wisconsin)	Secondary
363LP0200X	Nurse Practitioner - Pediatrics	209.010138 (Illinois)	Secondary
363LP0200X	Nurse Practitioner - Pediatrics	12260-33 (Wisconsin)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Mrs Jenell Diane Jackley allows following entities to bill medicare on her behalf.

Entity Name	Kenosha Community Health Center, Inc.
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1265435960 PECOS PAC ID: 0941195168 Enrollment ID: O20040217000840

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mrs Jenell Diane Jackley is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Mrs Jenell Diane Jackley, CPNP 316 Buck Trl, Twin Lakes, WI 53181-9637 Ph: (262) 914-1433	Mrs Jenell Diane Jackley, CPNP 4006 Washington Rd, Kenosha, WI 53144-4819 Ph: (262) 656-0044

Reviews and Comments

Nurse Practitioner Nurses in Kenosha, WI

Mrs. Susan H. Pergande, WHNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 10400 75th St, Kenosha, WI 53142 Phone: 262-948-6714
Katherine Jean Tura Spencer-schuerman, NURSE PRACTITIONER Nurse Practitioner Medicare: May Accept Medicare Assignments Practice Location: 4536 22nd Ave, Kenosha, WI 53140 Phone: 262-565-0044
Carly Worden, NP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 2707 15th Pl, Kenosha, WI 53140 Phone: 262-551-2700
Guadalupe Orlando Romero, NURSE PRACTITIONER Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 4777 88th Ave, Kenosha, WI 53144 Phone: 262-605-5253 Fax: 262-605-5903
Christine Marie Foster, APNP, RN Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 6525 Green Bay Rd, Ste. 2, Kenosha, WI 53142 Phone: 262-789-1191 Fax: 262-821-6180
Alejandra Moore, APNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 7401 104th Ave Ste 110, Kenosha, WI 53142 Phone: 262-764-5595 Fax: 262-764-9314
Quentin R Kasuboski, NP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 10400 75th St, Aurora Medical Center, Kenosha, WI 53142 Phone: 262-697-7000 Fax: 630-734-1560

Mrs Jenell Diane Jackley, CPNP - Medicare Nurse Practitioner in Kenosha, WI