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General NPI Number Information
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NPI Number | 1891724282
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Entity Type | Individual
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Provider Name | JENNIFER A LUNCEFORD PA
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Gender | Female
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 1730 B F TERRY BLVD STE 302
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City | ROSENBERG
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State | TX
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Zip | 77471-5535
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Country | US
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Telephone | 866-989-2873
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Fax | 713-568-3313
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Provider Business Mailing Address
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Address Line | 108 PENNY LN
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City | ATHENS
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State | TX
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Zip | 75751-3244
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Country | US
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Telephone | 903-386-3386
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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 | PA02328
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License Number State | TX
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