MEDICARE: JENNIFER A LUNCEFORD 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
1	363A00000X	Physician Assistant	PA02328	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8192NP	OTHER	TX	BCBS
2	P01492565	OTHER	TX	RAIL ROAD
3	7057548	OTHER	TX	AETNA
4	75-1976930-005	OTHER	TX	TRICARE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	8821NF	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1891724282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER A LUNCEFORD PA

Provider Business Mailing Address
First Line	:	108 PENNY LN
Second Line	:
City	:	ATHENS
State	:	TX
Zip	:	75751-3244
Country	:	US
Telephone Number	:	903-386-3386
Fax Number	:

Provider Business Practice Location Address
First Line	:	1730 B F TERRY BLVD STE 302
Second Line	:
City	:	ROSENBERG
State	:	TX
Zip	:	77471-5535
Country	:	US
Telephone Number	:	866-989-2873
Fax Number	:	713-568-3313

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

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	08/28/2024

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Directions to “ JENNIFER A LUNCEFORD PA” Practice Location

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