MEDICARE: JENNIFER CHAMPAGNE SOMMERS P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	PA047939	TX

General Provider Information

NPI Number	:	1215019427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER CHAMPAGNE SOMMERS P.A.

Provider Business Mailing Address
First Line	:	8865 SYNERGY DRIVE
Second Line	:	SUITE 100
City	:	MCKINNEY
State	:	TX
Zip	:	75070-6521
Country	:	US
Telephone Number	:	972-562-1119
Fax Number	:	972-529-9510

Provider Business Practice Location Address
First Line	:	8865 SYNERGY DRIVE
Second Line	:	SUITE 100
City	:	MCKINNEY
State	:	TX
Zip	:	75070-6521
Country	:	US
Telephone Number	:	972-562-1119
Fax Number	:	972-529-9510

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	09/12/2012

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