MEDICARE: MRS. PRISCILLA AYODELE JENEBA CHOUKROUN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	116462	IA
2	363A00000X	Physician Assistant	2712	SC
3	363A00000X	Physician Assistant	12924	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245770452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PRISCILLA AYODELE JENEBA CHOUKROUN PA-C

Provider Business Mailing Address
First Line	:	820 S RIVERSIDE DR # 1025
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52246-5611
Country	:	US
Telephone Number	:	319-281-4913
Fax Number	:

Provider Business Practice Location Address
First Line	:	3345 LOETHEN LN
Second Line	:
City	:	CORALVILLE
State	:	IA
Zip	:	52241-2626
Country	:	US
Telephone Number	:	469-536-1929
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2017
Last Update Date	:	02/11/2026

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