Provider Demographics
NPI:1053647909
Name:STERN, JENNIFER K (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:K
Last Name:STERN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9250 N 3RD ST
Mailing Address - Street 2:SUITE 3000
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-2437
Mailing Address - Country:US
Mailing Address - Phone:602-633-3710
Mailing Address - Fax:602-633-3711
Practice Address - Street 1:9250 N 3RD ST
Practice Address - Street 2:SUITE 3000
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2437
Practice Address - Country:US
Practice Address - Phone:602-633-3710
Practice Address - Fax:602-633-3711
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-28
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4542363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ506790Medicaid
AZZ136463Medicare PIN