Provider Demographics
NPI:1265016984
Name:JENNINGS, JAYLENE M (PA-C)
Entity Type:Individual
Prefix:
First Name:JAYLENE
Middle Name:M
Last Name:JENNINGS
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 1:1830 MEDITERRANEAN DR
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3144
Mailing Address - Country:US
Mailing Address - Phone:815-766-3873
Mailing Address - Fax:815-766-7713
Practice Address - Street 1:1830 MEDITERRANEAN DR
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3144
Practice Address - Country:US
Practice Address - Phone:815-766-3873
Practice Address - Fax:815-766-7713
Is Sole Proprietor?:No
Enumeration Date:2021-05-09
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085009139363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant