MEDICARE: MS. JENNIFER DONNELLY CUSHMAN PA-C

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	363AM0700X	Medical Physician Assistant
2	363A00000X	Physician Assistant	PAC0756	ND
3	363AM0700X	Medical Physician Assistant	PA61021112	WA
4	363A00000X	Physician Assistant	PA61021112	WA
5	363AM0700X	Medical Physician Assistant	PA2017-0003	NM
6	363A00000X	Physician Assistant	PA11037	TX
7	207R00000X	Internal Medicine Physician	PA2017-0003	NM

General Provider Information

NPI Number	:	1265985626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER DONNELLY CUSHMAN PA-C

Provider Business Mailing Address
First Line	:	7201 76TH ST
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79424-0722
Country	:	US
Telephone Number	:	806-239-3017
Fax Number	:

Provider Business Practice Location Address
First Line	:	7201 76TH ST
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79424-0722
Country	:	US
Telephone Number	:	806-239-3017
Fax Number	:

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

Provider Enumeration Date	:	08/02/2016
Last Update Date	:	03/18/2026

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