Healthcare Provider Details

I. General information

NPI: 1992204028
Provider Name (Legal Business Name): JENNIFER KAY LUCY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2018
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 MOSSIDE BLVD STE 405
MONROEVILLE PA
15146
US

IV. Provider business mailing address

2550 MOSSIDE BLVD STE 405
MONROEVILLE PA
15146-3533
US

V. Phone/Fax

Practice location:
  • Phone: 412-373-1600
  • Fax: 412-373-4197
Mailing address:
  • Phone: 412-373-1600
  • Fax: 412-373-4197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT004565
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA059696
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: