Healthcare Provider Details

I. General information

NPI: 1720081565
Provider Name (Legal Business Name): JENNIFER L. HARRINGTON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 S HIGHWAY 25 W # S SUITE 5
WILLIAMSBURG KY
40769-4600
US

IV. Provider business mailing address

841 S HIGHWAY 25 W # S SUITE 5
WILLIAMSBURG KY
40769-4600
US

V. Phone/Fax

Practice location:
  • Phone: 606-549-8521
  • Fax:
Mailing address:
  • Phone: 606-549-8521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA628
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA806
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: