Provider Demographics
NPI:1235380270
Name:DEGNAN, JENNY P (PA-C, ATC)
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:P
Last Name:DEGNAN
Suffix:
Gender:F
Credentials:PA-C, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 SAINT VINCENTS DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1636
Mailing Address - Country:US
Mailing Address - Phone:205-939-3699
Mailing Address - Fax:205-581-7155
Practice Address - Street 1:805 SAINT VINCENTS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1636
Practice Address - Country:US
Practice Address - Phone:205-939-3699
Practice Address - Fax:205-581-7155
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0106020542255A2300X
ALPA618363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL106435Medicaid