Healthcare Provider Details

I. General information

NPI: 1194716563
Provider Name (Legal Business Name): JENNIFER KRISTIN NAY P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 W HERNDON AVE
CLOVIS CA
93612-0204
US

IV. Provider business mailing address

PO BOX 28949
FRESNO CA
93729-8949
US

V. Phone/Fax

Practice location:
  • Phone: 559-324-6200
  • Fax:
Mailing address:
  • Phone: 559-228-4200
  • Fax: 559-224-3920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA17644
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: