Healthcare Provider Details

I. General information

NPI: 1447848981
Provider Name (Legal Business Name): JENNIFER LYNN WETHERBY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2021
Last Update Date: 07/07/2023
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7309 SENECA RD N
HORNELL NY
14843-9691
US

IV. Provider business mailing address

7309 SENECA RD N
HORNELL NY
14843-9691
US

V. Phone/Fax

Practice location:
  • Phone: 607-385-3700
  • Fax: 607-385-3160
Mailing address:
  • Phone: 607-385-3700
  • Fax: 607-385-3160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number310119
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF310119-01
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number527162
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: