Healthcare Provider Details

I. General information

NPI: 1649260944
Provider Name (Legal Business Name): JENNIFER LYNN OWINGS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 MORSE AVE NEUROSURGERY DEPARTMENT
SACRAMENTO CA
95825-2115
US

IV. Provider business mailing address

3187 ALDRIDGE WAY
EL DORADO HILLS CA
95762-9513
US

V. Phone/Fax

Practice location:
  • Phone: 925-628-5778
  • Fax:
Mailing address:
  • Phone: 925-628-5778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA18393
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: