Provider Demographics
NPI:1255003398
Name:ABERNATHY, JENNIE (PA)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:
Last Name:ABERNATHY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24500 CENTER RIDGE RD STE 375
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5631
Mailing Address - Country:US
Mailing Address - Phone:440-467-1954
Mailing Address - Fax:
Practice Address - Street 1:3665 W 117TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-5215
Practice Address - Country:US
Practice Address - Phone:216-251-5464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-28
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant