Healthcare Provider Details

I. General information

NPI: 1053751479
Provider Name (Legal Business Name): JENNIFER WHITNEY BROWN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER WHITNEY REYNOLDS

II. Dates (important events)

Enumeration Date: 06/29/2013
Last Update Date: 12/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4420 DUCKHORN DR SUITE 200
SACRAMENTO CA
95834-2590
US

IV. Provider business mailing address

4420 DUCKHORN DR SUITE 200
SACRAMENTO CA
95834-2590
US

V. Phone/Fax

Practice location:
  • Phone: 916-419-9900
  • Fax: 916-419-9699
Mailing address:
  • Phone: 916-419-9900
  • Fax: 916-419-9699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA23013
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: