Provider Demographics
NPI:1598217333
Name:JENNINGS, SAMUEL (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3488 GARDEN AVE
Mailing Address - Street 2:MIF 4
Mailing Address - City:JBSA FSH
Mailing Address - State:TX
Mailing Address - Zip Code:78324
Mailing Address - Country:US
Mailing Address - Phone:210-808-5406
Mailing Address - Fax:
Practice Address - Street 1:3488 GARDEN AVE
Practice Address - Street 2:MIF 4
Practice Address - City:JBSA FSH
Practice Address - State:TX
Practice Address - Zip Code:78324
Practice Address - Country:US
Practice Address - Phone:210-808-5406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant