Healthcare Provider Details

I. General information

NPI: 1376422295
Provider Name (Legal Business Name): JENNA BURNS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 S LOOP RD
EDGEWOOD KY
41017-3405
US

IV. Provider business mailing address

1360 INDIAN RIDGE TRL
NEW RICHMOND OH
45157-9124
US

V. Phone/Fax

Practice location:
  • Phone: 859-301-2663
  • Fax: 859-817-7848
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.009629RX
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberTC177
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: