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1720214398 NPI number — JENNIFER LYNN JENKINS PA-C

NPI Number: 1720214398
Health Care Provider/Practitioner: JENNIFER LYNN JENKINS PA-C

Information about “1720214398” NPI (JENNIFER LYNN JENKINS PA-C) exists in 1720214398 in HTML format HTML  |  1720214398 in plain Text format TXT  |  1720214398 in PDF (Portable Document Format) PDF  |  1720214398 in an XML format XML  formats.

NPI Number : 1720214398 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1720214398",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JENKINS",
    "FirstName": "JENNIFER",
    "MiddleName": "LYNN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MITCHELL",
    "OtherFirstName": "JENNIFER",
    "OtherMiddleName": "LYNN",
    "OtherNamePrefix": "MRS.",
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "118 NORTHPORT AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BELFAST",
    "MailingAddressStateName": "ME",
    "MailingAddressPostalCode": "04915-6072",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "207-505-4123",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "118 NORTHPORT AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BELFAST",
    "PracticeLocationAddressStateName": "ME",
    "PracticeLocationAddressPostalCode": "04915-6009",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "207-505-4123",
    "PracticeLocationAddressFaxNumber": "207-338-6820",
    "EnumerationDate": "06/09/2009",
    "LastUpdateDate": "05/05/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363AM0700X",
          "TaxonomyName": "Medical Physician Assistant",
          "LicenseNumber": "C0003960",
          "LicenseNumberStateCode": "MD",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363AM0700X",
          "TaxonomyName": "Medical Physician Assistant",
          "LicenseNumber": "PA1869",
          "LicenseNumberStateCode": "ME",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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