Provider Demographics
NPI:1558747246
Name:JENNINGS, CHARLES CALEB (PA-C)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:CALEB
Last Name:JENNINGS
Suffix:
Gender:M
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 1:9005 GRANT ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-4300
Mailing Address - Country:US
Mailing Address - Phone:303-287-2800
Mailing Address - Fax:303-287-7357
Practice Address - Street 1:9005 GRANT ST
Practice Address - Street 2:SUITE 200
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4300
Practice Address - Country:US
Practice Address - Phone:303-287-2800
Practice Address - Fax:303-287-7357
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0004290363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical