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NPI Code Detail

MEDICARE: JENNIFER K OWEN PA-C

MEDICARE: JENNIFER K OWEN 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
1363A00000XPhysician Assistant12699MN
2363A00000XPhysician AssistantPA-760AR

General Provider Information

NPI Number : 1578078622
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER K OWEN PA-C
Provider Business Mailing Address
First Line : 1651 E STEARNS ST STE 110
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72703-6196
Country : US
Telephone Number : 479-876-8550
Fax Number : 479-208-4266
Provider Business Practice Location Address
First Line : 1651 E STEARNS ST STE 110
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72703-6196
Country : US
Telephone Number : 479-876-8550
Fax Number : 479-208-4266
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2017
Last Update Date : 05/29/2026

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Directions to “ JENNIFER K OWEN PA-C” Practice Location

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