Provider Demographics
NPI:1306405790
Name:WARNER, JENNIFER LINDSAY (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LINDSAY
Last Name:WARNER
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 1:902 BLACKBURN ST
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-8494
Mailing Address - Country:US
Mailing Address - Phone:307-296-1355
Mailing Address - Fax:
Practice Address - Street 1:902 BLACKBURN ST
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-8494
Practice Address - Country:US
Practice Address - Phone:307-296-1355
Practice Address - Fax:307-586-5464
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
WYPA828363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant