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General NPI Number Information
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NPI Number | 1003144882
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Entity Type | Individual
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Provider Name | JESSICA LYNN FENNER PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/07/2009
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 3565 ROUTE 611 STE 300
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City | BARTONSVILLE
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State | PA
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Zip | 18321-7800
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Country | US
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Telephone | 484-526-6545
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Fax |
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Provider Business Mailing Address
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Address Line | 23 OAK LEAF LANE
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City | EAST STROUDSBURG
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State | PA
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Zip | 18301
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Country | US
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Telephone | 570-242-8876
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | OA003749
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License Number State | PA
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