Healthcare Provider Details

I. General information

NPI: 1790060481
Provider Name (Legal Business Name): JENNIFER LYNN DAY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER LYNN KISSINGER PA-C

II. Dates (important events)

Enumeration Date: 10/13/2011
Last Update Date: 05/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 E HIGH ST
SPRINGFIELD OH
45505-1412
US

IV. Provider business mailing address

6134 MOSS HILL CT
HUBER HEIGHTS OH
45424-1333
US

V. Phone/Fax

Practice location:
  • Phone: 937-325-0531
  • Fax:
Mailing address:
  • Phone: 937-902-2205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.003423RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: