Provider Demographics
NPI:1568832418
Name:WORRELL, JENNIFER (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:WORRELL
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 1:2975 STOCKYARD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1557
Mailing Address - Country:US
Mailing Address - Phone:406-203-1866
Mailing Address - Fax:
Practice Address - Street 1:2975 STOCKYARD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1557
Practice Address - Country:US
Practice Address - Phone:406-203-1866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant