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NPI Code Detail

MEDICARE: JESSICA A HENNINGSEN PA

MEDICARE: JESSICA A HENNINGSEN PA
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
1363A00000XPhysician AssistantSP561493OH
2363AM0700XMedical Physician Assistant50.004805RXOH
3363A00000XPhysician Assistant363A00000XKY

General Provider Information

NPI Number : 1699225482
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA A HENNINGSEN PA
Provider Business Mailing Address
First Line : 9301 DAYFLOWER ST STE 100
Second Line :
City : PROSPECT
State : KY
Zip : 40059-7585
Country : US
Telephone Number : 502-326-8588
Fax Number : 502-326-8589
Provider Business Practice Location Address
First Line : 9301 DAYFLOWER ST STE 100
Second Line :
City : PROSPECT
State : KY
Zip : 40059-7585
Country : US
Telephone Number : 502-326-8588
Fax Number : 502-326-8589
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2016
Last Update Date : 03/11/2025

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Directions to “ JESSICA A HENNINGSEN PA” Practice Location

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