Healthcare Provider Details

I. General information

NPI: 1649200072
Provider Name (Legal Business Name): JENNIFER L. ATKINS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 12/22/2020
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US 23 AT INDIANOLA AVENUE
SOUTH SHORE KY
41175
US

IV. Provider business mailing address

1735 27TH ST STE B06
PORTSMOUTH OH
45662-2681
US

V. Phone/Fax

Practice location:
  • Phone: 606-932-3159
  • Fax: 606-932-6896
Mailing address:
  • Phone: 740-356-8681
  • Fax: 740-353-7900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA454
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: