Provider Demographics
NPI:1346790417
Name:AINSWORTH, JENNA MARIE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:JENNA
Middle Name:MARIE
Last Name:AINSWORTH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:HABERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1006 TREETOPS BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-7645
Mailing Address - Country:US
Mailing Address - Phone:601-939-0005
Mailing Address - Fax:601-936-4949
Practice Address - Street 1:1006 TREETOPS BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-7645
Practice Address - Country:US
Practice Address - Phone:601-939-0005
Practice Address - Fax:601-936-4949
Is Sole Proprietor?:No
Enumeration Date:2016-10-12
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPA00303363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical