Healthcare Provider Details

I. General information

NPI: 1992463459
Provider Name (Legal Business Name): JENNIFER MYERS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2021
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 N 4TH ST STE B
MARTINS FERRY OH
43935-1648
US

IV. Provider business mailing address

90 N 4TH ST
MARTINS FERRY OH
43935-1648
US

V. Phone/Fax

Practice location:
  • Phone: 740-633-4480
  • Fax: 740-633-4485
Mailing address:
  • Phone: 740-633-4480
  • Fax: 740-633-4485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.008070RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: