MEDICARE: M JENNIFER CARMICHAEL MPA, 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	PA19133	CA

General Provider Information

NPI Number	:	1710102371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	M JENNIFER CARMICHAEL MPA, PA-C

Provider Business Mailing Address
First Line	:	10470 OLD PLACERVILLE RD
Second Line	:	SUITE 100
City	:	SACRAMENTO
State	:	CA
Zip	:	95827-2539
Country	:	US
Telephone Number	:	800-470-0071
Fax Number	:

Provider Business Practice Location Address
First Line	:	2382 MARITIME DR
Second Line	:	#100
City	:	ELK GROVE
State	:	CA
Zip	:	95758-3639
Country	:	US
Telephone Number	:	916-691-6622
Fax Number	:

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

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	02/18/2022

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