Provider Demographics
NPI:1477540268
Name:BURNER, JENNIFER (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:BURNER
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 1:70 N STURMER ST
Mailing Address - Street 2:
Mailing Address - City:BELINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26250-7403
Mailing Address - Country:US
Mailing Address - Phone:304-823-2800
Mailing Address - Fax:
Practice Address - Street 1:70 N STURMER ST
Practice Address - Street 2:
Practice Address - City:BELINGTON
Practice Address - State:WV
Practice Address - Zip Code:26250-7403
Practice Address - Country:US
Practice Address - Phone:304-823-2800
Practice Address - Fax:304-823-2703
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV00648363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1477540268Medicaid
WV3810000531Medicaid
WVP00276763OtherRAILROAD MEDICARE
WVWV1327COtherMEDICARE PTAN
WVPA19462Medicare PIN
WVP66385Medicare UPIN