Healthcare Provider Details

I. General information

NPI: 1083056469
Provider Name (Legal Business Name): JENNIFER ALEXIS GILPIN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2013
Last Update Date: 10/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SCRIPPS DR STE 202
SACRAMENTO CA
95825-6206
US

IV. Provider business mailing address

5533 CLARK AVE
CARMICHAEL CA
95608-4749
US

V. Phone/Fax

Practice location:
  • Phone: 916-927-1114
  • Fax:
Mailing address:
  • Phone: 916-834-9463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number23112
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: