Healthcare Provider Details

I. General information

NPI: 1003144882
Provider Name (Legal Business Name): JESSICA LYNN FENNER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2009
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3565 ROUTE 611 STE 300
BARTONSVILLE PA
18321-7800
US

IV. Provider business mailing address

23 OAK LEAF LANE
EAST STROUDSBURG PA
18301
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-6545
  • Fax:
Mailing address:
  • Phone: 570-242-8876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA003749
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: