Provider Demographics
NPI:1518007764
Name:ARNOLD, JENNIFER ARDIS (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ARDIS
Last Name:ARNOLD
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 1:221 RUSSELLTON DORSEYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CHESWICK
Mailing Address - State:PA
Mailing Address - Zip Code:15024-2004
Mailing Address - Country:US
Mailing Address - Phone:412-767-5394
Mailing Address - Fax:412-767-5212
Practice Address - Street 1:20630 ROUTE 19 UNIT 101
Practice Address - Street 2:
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066-6021
Practice Address - Country:US
Practice Address - Phone:724-779-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA-OO2374363AM0700X
PAMA050862363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00220765Medicaid
PA078634LOXMedicare ID - Type Unspecified
PAP00220765Medicaid