Healthcare Provider Details

I. General information

NPI: 1306834866
Provider Name (Legal Business Name): JENNIFER P KLINE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER D PATTON PA-C

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 11/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 CLOVERLEAF RD
ELIZABETHTOWN PA
17022-9320
US

IV. Provider business mailing address

306 N 7TH ST
COLUMBIA PA
17512-2137
US

V. Phone/Fax

Practice location:
  • Phone: 717-653-1467
  • Fax: 717-653-1001
Mailing address:
  • Phone: 717-684-9106
  • Fax: 717-684-1666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA002480L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: