Provider Demographics
NPI:1326054230
Name:GUTHRIE, JENNIFER RENEE (PAC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RENEE
Last Name:GUTHRIE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2026 N EWING ST
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-3480
Mailing Address - Country:US
Mailing Address - Phone:812-524-3333
Mailing Address - Fax:812-524-3334
Practice Address - Street 1:2026 N EWING ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-3480
Practice Address - Country:US
Practice Address - Phone:812-524-3333
Practice Address - Fax:812-524-3334
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000450A363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN10000450AOtherHEALTH PROFESSIONS BUREAU
IN1000450AOtherINDIANA LICENSE