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NPI Code Detail

MEDICARE: JENNIE ABERNATHY PA

MEDICARE: JENNIE ABERNATHY PA
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
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1255003398
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIE ABERNATHY PA
Provider Business Mailing Address
First Line : 24500 CENTER RIDGE RD STE 375
Second Line :
City : WESTLAKE
State : OH
Zip : 44145-5631
Country : US
Telephone Number : 440-467-1954
Fax Number :
Provider Business Practice Location Address
First Line : 3665 W 117TH ST
Second Line :
City : CLEVELAND
State : OH
Zip : 44111-5215
Country : US
Telephone Number : 216-251-5464
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2021
Last Update Date : 12/07/2021

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