Provider Demographics
NPI:1306834866
Name:KLINE, JENNIFER P (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:P
Last Name:KLINE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:D
Other - Last Name:PATTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:306 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:PA
Mailing Address - Zip Code:17512-2137
Mailing Address - Country:US
Mailing Address - Phone:717-684-9106
Mailing Address - Fax:717-684-1666
Practice Address - Street 1:418 CLOVERLEAF RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:PA
Practice Address - Zip Code:17022-9320
Practice Address - Country:US
Practice Address - Phone:717-653-1467
Practice Address - Fax:717-653-1001
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002480L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1552980OtherGATEWAY HEALTH PLAN
PAP59396OtherHEALTH ASSURANCE
PA50008366OtherCAPITAL BLUE CROSS
PAP59396Medicare UPIN
PA1552980OtherGATEWAY HEALTH PLAN
PA054650G21Medicare PIN
PA054650RHNMedicare PIN